Endoscopic sphincterotomy prior to biliary stenting may prevent PEP in biliary structures
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Endoscopic sphincterotomy performed before endoscopic biliary stenting may prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with biliary structures, according to a presentation at UEG week.
“The incidence of [post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP)] was significantly higher in the non-ES group,” Shin Kato, MD, of the department of gastroenterology and hepatology at Hokkaido University Hospital in Sapporo, Japan, said during his presentation. “The non-inferiority of non-ES to ES before endoscopic biliary stent was not certified. The incidence of bleeding was significantly higher in the ES group.”
Kato and colleagues randomly assigned 370 patients with biliary stricture requiring endoscopic biliary stenting to either the endoscopic sphincterotomy group (n = 185) or the non-endoscopic sphincterotomy group (n = 185). Patients were followed for 30 days after the procedure.
The incidence of PEP within 2 days of initial transpapillary biliary drainage served as the primary outcome. Other outcomes included incidence of other adverse events such as cholangitis, cholecystitis, perforation, bleeding and recurrent biliary obstruction related to biliary stent/tube placement and ES.
Kato and colleagues prospectively corrected the occurrence of adverse events.
Investigators found PEP occurred in 36 patients in the non-ES group compared with seven in the ES group (P < .001).
Based on the per-protocol population, the differences in PEP incidence between the two groups was 16.7% (95% CI, 10.1%-23.3%). This was not within the set non-inferiority margin of 6%, according to Kato. Similarly, this was also observed in the ITT setting (15.7%; 95% CI, 9.3%-22%).
According to Kato, apart from bleeding, the incidence of other adverse events was not significantly different between the non-ES and ES groups.
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Kato S, et al. Abstract OP132. Presented at: UEG Week; Oct. 3-5, 2021 (virtual meeting).
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