Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis

World J Gastroenterol. 2014 Oct 14;20(38):14033-9. doi: 10.3748/wjg.v20.i38.14033.


Aim: To investigate the benefits of endoscopic sphincterotomy (EST) before stent placement by meta-analysis of randomized controlled trials (RCTs).

Methods: PubMed, EMBASE, Cochrane Library, and Science Citation Index databases up to March 2014 were searched. The primary outcome was incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and successful stent insertion rate. The secondary outcomes were the incidence of post-ERCP bleeding, stent migration and occlusion. The free software Review Manager was used to perform the meta-analysis.

Results: Three studies (n = 338 patients, 170 in the EST group and 168 in the non-EST group) were included. All three studies described a comparison of baseline patient characteristics and showed that there were no statistically significant differences between the two groups. Three RCTs, including 338 patients, were included in this meta-analysis. Most of the analyzed outcomes were similar between the groups. Although EST reduced the incidence of PEP, it also led to a higher incidence of post-ERCP bleeding (OR = 0.34, 95%CI: 0.12-0.93, P = 0.04; OR = 9.70, 95%CI: 1.21-77.75, P = 0.03, respectively).

Conclusion: EST before stent placement may be useful in reducing the incidence of PEP. However, EST-related complications, such as bleeding and perforation, may offset this effect.

Keywords: Biliary stent; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Malignant biliary obstruction.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Chi-Square Distribution
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde / instrumentation*
  • Cholestasis / diagnosis
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Drainage / adverse effects
  • Drainage / instrumentation*
  • Humans
  • Neoplasms / complications*
  • Neoplasms / pathology
  • Odds Ratio
  • Pancreatitis / etiology
  • Postoperative Hemorrhage / etiology
  • Prosthesis Failure
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sphincterotomy, Endoscopic* / adverse effects
  • Stents*
  • Treatment Outcome