Endoscopic Sphincterotomy Prior to Biliary Stenting for Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
In brief
Endoscopic sphincterotomy cuts pancreatitis risk by about 77% in non-pancreatic cancer biliary obstruction
In a meta-analysis of six randomized trials (1,215 patients), performing sphincterotomy before stent placement did not change technical success, bleeding, or other complications, but it lowered post-ERCP pancreatitis rates to roughly one-quarter of the risk when pancreatic cancer was uncommon. No pancreatitis benefit was seen in cohorts dominated by pancreatic cancer, suggesting the maneuver's value depends on tumor type.
- Journal
- Journal of gastroenterology and hepatology (Q1)
- Published
- 4 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Sofia Coelho Meine, Gabriel de Oliveira Amaral, Mateus Rech Tedesco, João Pedro Schmitt, Gabrielle Knackfuss D'Aiuto, Gilmara Coelho Meine
- PMID
- 42694002
- DOI
- 10.1111/jgh.70714
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 6 September 2026): Endoscopic sphincterotomy before biliary stenting meta‑analysis
Abstract
BACKGROUND AND AIMS: ERCP-guided biliary stenting is the usual palliative treatment for patients with unresectable malignant biliary obstruction (MBO). Previous studies suggested that ES prior to biliary stenting may not reduce the post-ERCP pancreatitis (PEP) risk and may increase bleeding risk. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of ES prior to biliary stenting in patients with MBO, with a particular focus on the impact of MBO etiology and stent type. METHODS: We systematically searched for randomized controlled trials (RCTs) comparing ERCP-guided biliary stenting with versus without ES in patients with MBO. We estimated the pooled risk ratios (RRs) with respective 95% confidence intervals (CIs) using a random-effects model. RESULTS: Six RCTs (1215 patients) were included. Technical success and the risk of PEP, clinically significant bleeding, perforation, cholangitis, cholecystitis, and stent malfunction were similar between the groups. Subgroup analyses by MBO etiology and stent type were consistent with overall analysis, except for PEP by MBO etiology. ES reduced PEP risk in studies with a low prevalence of pancreatic cancer (RR 0.23; 95% CI 0.12-0.44), but no significant difference was observed in studies with a high prevalence of pancreatic cancer (RR 0.85; 95% CI 0.57-1.28). CONCLUSION: The risk of clinically significant bleeding was similar with or without ES prior to biliary stenting for MBO. ES was associated with a reduced PEP risk in studies with a low prevalence of pancreatic cancer, whereas no benefit was observed in studies with a high prevalence of pancreatic cancer.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.