[The safety assessment of percutaneous transhepatic transpapillary stent insertion in malignant obstructive jaundice: regarding the risk of pancreatitis and the effect of preliminary endoscopic sphincterotomy].
OBJECTIVE
Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track.


METHODS
A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were divided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group.


RESULTS
The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614).


CONCLUSIONS
Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.
Jeong
Young Wook
YW
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
Shin
Kyong Deok
KD
Kim
Seong Hun
SH
Kim
In Hee
IH
Kim
Sang Wook
SW
Lee
Kyong Ae
KA
Jeon
Byung Jun
BJ
Lee
Seung Ok
SO
D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism; D002779:Cholestasis / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic; D015607:Stents / Q000009:adverse effects*
D000681:Amylases