Endoscopy 2019; 51(04): S38
DOI: 10.1055/s-0039-1681280
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ERCP stenosis Club H
Georg Thieme Verlag KG Stuttgart · New York

NO BENEFIT OF PERFORMING ENDOSCOPIC SPHINCTEROTOMY BEFORE STENT PLACEMENT IN PATIENTS WITH DISTAL MALIGNANT BILIARY STRICTURES: A META-ANALYSIS OF RCTS

A Tringali
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
E Stasi
2   Gastroenterology and Endoscopy, IRCCS De Bellis, Castellana Grotte, Italy
,
M Cintolo
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
E Forti
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
F Pugliese
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
L Dioscoridi
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
DG Adler
3   Gastroenterology and Hepatology, University of Utah, Salt Lake City, United States
,
M Mutignani
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic sphincterotomy (ES) before stent placement in patients with distal malignant biliary obstruction is still a controversial issue. Some authors suggested that ES before stent deployment has a protective role in avoiding the risk of post ERCP pancreatitis but this attitude is not currently evidence-based. We performed a systematic review and meta-analysis to investigate the role of ES versus non endoscopic sphincterotomy (NES) before stent placement in patients with distal malignant biliary strictures.

Methods:

We searched multiple databases (Medline, Embase, Cochrane) to identify RCTs comparing the execution of ES vs. NES before stent placement in patients with distal malignant biliary obstruction. Outcome measures were the risk of PEP, successful stent insertion, stent migration, cholangitis, bleeding and procedure time. Results were reported as odds ratios (OR) with 95% confidence intervals (95% CI) Fixed and random models were used as appropriate. Heterogeneity was assessed by measuring I2.

Results:

we identified 4 RCTs for a total of 548 patients respectively randomized to ES (274) and to NES (274). No difference emerged in the rate of PEP (OR 0.62 95% CI 0.21 – 1.88), nor in stent migration (OR 1.71 95% CI 0.60 – 4.87), bleeding (OR1.18 95% CI 0.03 – 40.74) and successful stent insertion (OR. 1.70 95% CI 0.60 – 4.79). Unfortunately, only one RCT reported bleeding and procedure time rates, favoring NES (p = 0.02).

Conclusions:

There is no increased risk of PEP in the NES group compared to ES before stent placement in patients with distal malignant biliary obstruction. According to our data, ES is not mandatory. However, due to the small number of patients and the study heterogeneity more RCTs are required before a firm recommendation could be made.