Is a Sphincterotomy Needed for Metal Biliary Stent Placement in Patients Without Pancreatic Obstruction?

There is ongoing debate in the endoscopy community as to whether the placement of a metal biliary stent warrants a concomitant biliary sphincterotomy. Those in favor of sphincterotomy suggest that it takes pressure off of the pancreatic duct and reduces the rate of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Others cite low rates of PEP when not performing sphincterotomy in this setting and argue that this maneuver only adds time and risk to the procedure.

To provide further data on this issue, investigators in Japan conducted a multicenter, retrospective study in 160 patients undergoing metal biliary stent placement for malignant biliary obstruction without concomitant pancreatic duct obstruction (the subg…