Korean J Gastroenterol.  2009 Dec;54(6):390-394. 10.4166/kjg.2009.54.6.390.

The Safety Assessment of Percutaneous Transhepatic Transpapillary Stent Insertion in Malignant Obstructive Jaundice: Regarding the Risk of Pancreatitis and the Effect of Preliminary Endoscopic Sphincterotomy

• Jeong YW
• Shin KD
• Kim SH
• Kim IH
• Kim SW
• Lee KA
• Jeon BJ
• Lee SO

• KMID: 1775939
• DOI: http://doi.org/10.4166/kjg.2009.54.6.390

Abstract

BACKGROUND/AIMS
Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. METHODS: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. RESULTS: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). CONCLUSIONS: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.

Keyword

Percutaneous transhepatic biliary drainage; Endoscopic sphincterectomy; Pancreatitis; Biliary stent

MeSH Terms

Aged
Aged, 80 and over
Amylases/metabolism
Cholestasis/diagnosis/*surgery
Drainage
Female
Humans
Jaundice, Obstructive/diagnosis/*surgery
Male
Middle Aged
Pancreatitis/*etiology
Retrospective Studies
Risk Assessment
Sphincterotomy, Endoscopic
Stents/*adverse effects

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