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Original
A Two-institution study of risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography for transpapillary biliary stent placement in patients with malignant biliary obstruction

Ryuichi Yamamoto^1)＊, Ko Nishikawa²⁾, Shuko Ishida¹⁾, Masatomo Takahashi¹⁾, Maiko Harada¹⁾, Yasuyo Osafune¹⁾, Shingo Kato¹⁾,
Sumiko Nagoshi¹⁾, Koji Yakabi¹⁾

1) Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
2) Department of the Gastroenterology, Ageo Central General Hospital, Ageo, Saitama Prefecture, Japan

【Objectives】
　To evaluate the risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) for biliary stent placement in patients with malignant biliary obstruction (MBO).

【Methods】
　This retrospective study included consecutive MBO patients who underwent ERCP-guided transpapillary biliary stent placement over a period of 5.5 years at two tertiary referral academic medical centers. Of 100 eligible patients identified, 67 received a WallflexTM self-expandable metallic stent (Boston Scientific Cooperation, Japan; SEMS group) and 33 received a FleximaTM plastic stent (Boston Scientific; PS group). The etiology of MBO was similar between the two groups, with pancreatic cancer accounting for 53% cases. The main outcome measurements were identifiable risk factors for post-ERCP pancreatitis (PEP).

【Results】
　The overall PEP rate was 3.0%, with no significant difference between the SEMS and PS groups. Totally, 7.1% and 2.3% patients who did and did not undergo endoscopic sphincterotomy (EST) before biliary stenting, respectively, developed PEP. The median duration of stent patency in the 8-mm SEMS, 10-mm SEMS, and PS groups was 136, 140, and 79 days, respectively, for patients with pancreatic cancer and in the 8-mm SEMS, 10-mm SEMS, and PS groups was 126, 166, and 137 days, respectively, for patients without pancreatic cancer. Multivariate analysis identified 6 factors that were not associated with PEP. PEP rates according to the presence or absence of EST before stent placement, stent type, stent size, and indications were not significantly different.

【Conclusions】
　The characteristics of the biliary stent and the performance of EST before stent placement are not significant risk factors for PEP in patients with MBO who underwent transpapillary biliary stent placement.

J Saitama Medical University 2014; 41: 1-6
(Received March 27, 2014 / Accepted July 2, 2014)

Keywords: post ERCP pancreatitis, malignant biliary obstruction