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Abstract
Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis
after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic
sphincter hypertension is the likely explanation for this increased risk. A prospective,
randomized controlled trial was conducted to determine if ductal drainage with pancreatic
stenting protects against pancreatitis after biliary sphincterotomy in patients with
pancreatic sphincter hypertension.
Eligible patients with pancreatic sphincter hypertension were randomized to groups
with pancreatic duct stents (n = 41) or no stents (n = 39) after biliary sphincterotomy.
The primary measured outcome was pancreatitis after endoscopic retrograde cholangiopancreatography
(ERCP).
Pancreatic stenting significantly decreased the risk of pancreatitis from 26% to 7%
(10 of 39 in the no stent group and 3 of 41 in the stent group; P = 0.03). Only 1
patient in the stent group developed pancreatitis after sphincterotomy, and 2 others
developed pancreatitis at the time of stent extraction. Patients in the no stent group
were 10 times more likely to develop pancreatitis immediately after sphincterotomy
than those in the stent group (relative risk, 10.5; 95% confidence interval, 1.4-78.3).
Pancreatic duct stenting protects significantly against post-ERCP pancreatitis in
patients with pancreatic sphincter hypertension undergoing biliary sphincterotomy.
Stenting of the pancreatic duct should be strongly considered after biliary sphincterotomy
for sphincter of Oddi dysfunction; pancreatic sphincter of Oddi manometry identifies
which high-risk patients may benefit from pancreatic stenting.