Comparison of bile duct pressures following sphincterotomy and endobiliary stenting in a canine model.
BACKGROUND
Cystic duct (CD) leaks following laparoscopic cholecystectomy may be diagnosed and managed with ERCP. Treatment options include endoscopic sphincterotomy (ES) and/or endobiliary stenting (Stent). This study was undertaken to determine if ES or Stent is more effective in lowering bile duct pressures by disrupting the pressure gradient created by the sphincter of Oddi and therefore more beneficial in the management of CD.


METHODS
Mongrel dogs underwent midline laparotomy and antegrade cannulation of the common bile duct (CBD) with an umbilical artery catheter. Baseline CBD pressures were measured following duodenotomy; 5 Fr and 7 Fr stents measuring 2.5 cm, 4.5 cm, and 7 cm were inserted retrograde into the CBD. CBD pressure was measured after each stent insertion. A 1-cm sphincterotomy was the performed using a double channel papillotome.


RESULTS
Insertion of both 5 Fr and 7 Fr stents significantly lowered CBD pressure as compared to sphincterotomy alone, p < 0.05. There was no significant difference in the reduction in CBD pressure following the insertion of either the 5 Fr or 7 Fr stents of varying lengths. Sphincterotomy alone did not significantly decrease CBD pressure as compared to baseline pressure. The insertion of a stent following sphincterotomy also caused a significant decrease in CBD pressure as compared to sphincterotomy alone, p = 0.034.


CONCLUSIONS
Stent placement or ES with Stent placement significantly reduced CBD pressure as compared to ES alone. Stent diameter and length were not significant variables in this study. These results support the use of Stent or ES with Stent rather than ES alone in the management of CD leaks.
Youngelman
D F
DF
Department of Surgery, The Mt. Sinai Medical Center, One Mt. Sinai Drive, Cleveland, OH 44106, USA.
Marks
J M
JM
Ponsky
T
T
Ponsky
J L
JL
D000818:Animals; D003135:Common Bile Duct / Q000502:physiology*; D004195:Disease Models, Animal; D004285:Dogs; D019723:Endoscopes; D011312:Pressure; D009803:Sphincter of Oddi / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D015607:Stents; D016896:Treatment Outcome