Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction.
OBJECTIVE
To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).


METHODS
This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified.


RESULTS
Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinomavspancreatic cancervsothers,P= 0.696) or the type of SEMS used (uncoveredvscovered,P= 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMSvstwo SEMS,P= 0.031). No other factors were predictive of post-ERCP complications.


CONCLUSIONS
Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Hyeong Seok
HS
Nam
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Dae Hwan
DH
Kang
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Hyung Wook
HW
Kim
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Cheol Woong
CW
Choi
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Su Bum
SB
Park
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Su Jin
SJ
Kim
Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Su Jin Kim, Dae Gon Ryu, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Dae Gon
DG
Ryu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic; D001659:Biliary Tract; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002779:Cholestasis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D061214:Patient Safety; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
D008670:Metals
Bleeding; Cholestasis; Complications; Endoscopic retrograde cholangio pancreatography; Endoscopic sphincterotomy; Pancreatitis; Self-expandable metal stent