P-170 - Efficiency of minor endoscopic sphincterotomy for biliary stenting in malignant biliary obstruction

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Hepatobiliary Cancers
Surgery and/or Radiotherapy of Cancer
Presenter J.H. Kim
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors J.H. Kim, S.K. Oh, D.H. Kang, H.W. Kim, C.W. Choi, S.B. Park, S.J. Kim, J.G. Shin
  • Pusan National University Yangsan Hospital, Yangsan/KR

Abstract

Introduction

Pancreatitis is common complications post-ERCP and after self-expanding metal stent (SEMS) placement. Endoscopic sphincterotomy (ES) can reduce the risk of post-ERCP pancreatitis (PEP). But sphincterotomy has many complications like bleeding, perforation. In this study, we study about complication like PEP and bleeding in patients with minor ES for biliary drainage with SEMS.

Methods

We studied about 167 patients with unresectable pancreaticobiliary malignancies who received SEMSs with minor ES by retrospective analysis. In 167 patient, 94 patients was cholangiocarcinoma, 49 patients was pancreatic cancer, 13 patients was gallbladder cancer, and 21 patients was non-pancreaticobiliary malignancy like ampullary carcinoma, hepatocellular carcinoma, metastatic cancer. Complication including PEP and bleeding rate were evaluated.

Results

In this study, there were 167 subjects with 135 uncovered SEMSs and 32 covered SEMSs. The pancreatitis after SEMS insertion was founded in 11 patients (6.5%). No significant differences between covered and uncovered SEMSs were noted in frequency of PEP (3.3%, 5.5%, respectively)(p = 0.231). Bleeding after minor ES was reported in 1.1% (2/167). But it is not significant bleeding that requires blood transfusion.

Conclusion

The placement of SEMS with minor ES is better comparable with the incidence of PEP in previous large clinical trials. Post ES bleeding was lower in minor ES comparable to standard sphincterotomy. The bleeding rate of SEMS insertion after minor ES was lower compared with standard sphincterotomy prior to stent placement. Minor ES was safe and effective procedure as not increasing severe bleeding to facilitate the SEMS placement in patients with malignant biliary obstruction.