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Kato S, Kuwatani M, Hayashi T, Eto K, Ono M, Ehira N, Yamato H, Sano I, Taya Y, Onodera M, Kubo K, Ihara H, Yamazaki H, Sakamoto N. Inutility of endoscopic sphincterotomy to prevent pancreatitis after biliary metal stent placement in the patients without pancreatic duct obstruction. Scand J Gastroenterol 2020; 55:503-508. [PMID: 32275454 DOI: 10.1080/00365521.2020.1749879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The incidence of post-ERCP pancreatitis (PEP) has been reported to be significantly higher in patients without main pancreatic duct (MPD) obstruction who undergo transpapillary biliary metal stent (MS) placement than in those with ordinary ERCP setting.Objective: To evaluate the benefit of endoscopic sphincterotomy (ES) prior to MS placement in preventing PEP in patients with distal malignant biliary obstruction (MBO) without MPD obstruction.Materials and methods: In total, 160 patients who underwent initial MS placement for MBO were enrolled. Eighty-two patients underwent ES immediately prior to MS placement, whereas 78 underwent MS placement without ES. An inverse probability of treatment weighting method was adopted to adjust the differences of the patients' characteristics. The primary outcome was the incidence of PEP. The secondary outcomes included the incidence of other adverse events (bleeding, cholangitis, perforation and stent dislocation) and time to recurrent biliary obstruction.Results: The incidence of PEP was 26.8% in the ES and 23.1% in the non-ES (unadjusted odds ratio [OR] [95%CI]: 1.22, [0.60-2.51], adjusted OR [95%CI]: 1.23, [0.53-2.81], p = .63). Logistic-regression analysis revealed no factors that could be attributed to the occurrence of PEP. The incidence of other adverse events was not different between the groups. The median time to recurrent biliary obstruction was 131 (2-465) days and 200 (4-864) days in the ES and non-ES, respectively (p = .215).Conclusions: ES prior to MS placement for patients with distal MBO without MPD obstruction does not reduce the incidence of PEP.
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Affiliation(s)
- Shin Kato
- Department of Gastroenterology and Hepatology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kazunori Eto
- Department of Gastroenterology, Tomakomai Municipal Hospital, Tomakomai, Japan
| | - Michihiro Ono
- Department of Gastroenterology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Nobuyuki Ehira
- Department of Gastroenterology, Kitami Red Cross Hospital, Kitami, Japan
| | - Hiroaki Yamato
- Department of Gastroenterology, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Itsuki Sano
- Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Yoko Taya
- Department of Gastroenterology, NHO Hokkaido Medical Center, Sapporo, Japan
| | - Manabu Onodera
- Department of Gastroenterology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Kimitoshi Kubo
- Department of Gastroenterology, NHO Hakodate Hospital, Hakodate, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, KKR Tonan Hospital, Sapporo, Japan
| | - Hajime Yamazaki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
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Kawakubo K, Kuwatani M, Kato S, Sakamoto N. Better too big than too small? Gastrointest Endosc 2019; 89:650-651. [PMID: 30784508 DOI: 10.1016/j.gie.2018.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/29/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Shin Kato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
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Martins FP, De Paulo GA, Contini MLC, Ferrari AP. Response. Gastrointest Endosc 2019; 89:651-652. [PMID: 30784509 DOI: 10.1016/j.gie.2018.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 02/08/2023]
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