Routine biliary sphincterotomy may not be indispensable for endoscopic pancreatic sphincterotomy

Area of Science:

• Gastroenterology
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Pancreatic diseases

Background:

• Biliary sphincterotomy is often performed with pancreatic sphincterotomy to prevent post-procedure complications like cholestasis and infection.
• The necessity of dual sphincterotomy has not been confirmed by prospective randomized trials.
• This study aimed to evaluate the incidence of cholangitis after pancreatic sphincterotomy alone versus dual sphincterotomy.

Purpose of the Study:

• To determine if concomitant biliary sphincterotomy is required during endoscopic pancreatic sphincterotomy.
• To assess the frequency of cholangitis development in patients undergoing pancreatic sphincterotomy alone versus dual sphincterotomy.

Main Methods:

• A prospective randomized study involving 60 patients with non-alcoholic chronic calcifying pancreatitis.
• Patients were randomized into two groups: dual sphincterotomy (Group I) or pancreatic sphincterotomy alone (Group II).
• Subgroup analysis was performed based on serum alkaline phosphatase levels and common bile duct diameter.

Main Results:

• Cholangitis occurred in 56% of patients in the subgroup with abnormal serum alkaline phosphatase and common bile duct diameter who underwent pancreatic sphincterotomy alone (Group IIA).
• In contrast, cholangitis rates were significantly lower in other groups, including those with dual sphincterotomy.
• Pancreatitis and hemorrhage rates were comparable across the groups.

Conclusions:

• Dual sphincterotomy is recommended only for patients with chronic pancreatitis exhibiting both a dilated common bile duct and elevated alkaline phosphatase.
• Routine biliary sphincterotomy may not be essential for all patients undergoing pancreatic sphincterotomy.
• Selective application of biliary sphincterotomy can potentially reduce invasive procedures without increasing cholangitis risk.