title: Does endoscopic sphincterotomy reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis after biliary stenting? A systematic review and meta-analysis.
abstract: OBJECTIVE
  Endoscopic biliary sphincterotomy (ES) is often carried out prior to placement of a biliary stent apparently to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, the protective effect of ES prior to biliary stenting is controversial. The objective of this meta-analysis is to compare the risk of PEP and other complications after the placement of biliary stent with or without ES in patients with biliary obstruction and bile leak.
  
  
  METHODS
  We carried out a systematic search in several electronic databases for randomized controlled trials (RCT) and observational studies (OS) comparing the risk of PEP after biliary stenting with or without ES. The Mantel-Haenszel method was used to pool data of adverse outcomes into fixed or random effect model meta-analyses.
  
  
  RESULTS
  Seventeen studies (five RCT and 12 OS) with a total of 2710 patients met the inclusion criteria. No significant difference was observed in the risk of PEP with biliary stenting with and without ES (RD -0.01; 95% confidence interval [CI] -0.03, 0.01). In a subgroup analysis of stenting for biliary obstruction, no difference in the risk of PEP was observed with or without ES. However, ES was associated with lower risk of PEP in patients undergoing biliary stenting for bile leak (RD -0.05; CI -0.10, -0.01).
  
  
  CONCLUSIONS
  ES shows risk reduction in prevention of PEP in patients undergoing endoscopic stenting for bile leak. However, placement of biliary stent without ES is not associated with an increased risk of PEP in patients with distal bile duct obstruction with involvement of pancreatic duct.
authors.affiliation: Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.
authors.forename: Aijaz Ahmed
authors.initials: AA
authors.lastname: Sofi
authors.affiliation: Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Nawras
authors.affiliation: Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.
authors.forename: Osama Habib
authors.initials: OH
authors.lastname: Alaradi
authors.affiliation: Departments of Internal Medicine, University of Toledo Medical Center, Toledo, USA.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Alastal
authors.affiliation: Departments of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, USA.
authors.forename: Muhammed Ali
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Departments of Internal Medicine, University of Toledo Medical Center, Toledo, USA.
authors.forename: Wade M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D000074432:Sphincterotomy; D016717:Sphincterotomy, Endoscopic; D015607:Stents
keywords: ERCP; acute pancreatitis; biliary stents; complications; sphincterotomy