title: Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis.
abstract: OBJECTIVE
  To investigate the benefits of endoscopic sphincterotomy (EST) before stent placement by meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library, and Science Citation Index databases up to March 2014 were searched. The primary outcome was incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and successful stent insertion rate. The secondary outcomes were the incidence of post-ERCP bleeding, stent migration and occlusion. The free software Review Manager was used to perform the meta-analysis.
  
  
  RESULTS
  Three studies (n = 338 patients, 170 in the EST group and 168 in the non-EST group) were included. All three studies described a comparison of baseline patient characteristics and showed that there were no statistically significant differences between the two groups. Three RCTs, including 338 patients, were included in this meta-analysis. Most of the analyzed outcomes were similar between the groups. Although EST reduced the incidence of PEP, it also led to a higher incidence of post-ERCP bleeding (OR = 0.34, 95%CI: 0.12-0.93, P = 0.04; OR = 9.70, 95%CI: 1.21-77.75, P = 0.03, respectively).
  
  
  CONCLUSIONS
  EST before stent placement may be useful in reducing the incidence of PEP. However, EST-related complications, such as bleeding and perforation, may offset this effect.
authors.affiliation: Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Pei-Jing
authors.initials: PJ
authors.lastname: Cui
authors.affiliation: Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yao
authors.affiliation: Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Hua-Zhong
authors.initials: HZ
authors.lastname: Han
authors.affiliation: Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
mesh_terms: D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D015607:Stents; D016896:Treatment Outcome
keywords: Biliary stent; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Malignant biliary obstruction