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• W2091218084 abstract "To the Editor: We read with great interest the study by Okamoto et al.1Okamoto T. Fujioka S. Yanagisawa S. et al.Placement of a metallic stent across the main papilla may predispose to cholangitis.Gastrointest Endosc. 2006; 63: 792-796Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar The investigators concluded that a biliary metallic stent across the main papilla may predispose patients to cholangitis by disrupting the sphincter mechanism. In addition to this factor, intervention on the sphincter of Oddi (SO) may be important but was not evaluated in this study. In previous Japanese reports2Isayama H. Komatsu Y. Tsujino T. et al.A prospective randomised study of covered versus uncovered diamond stents for the management of distal malignant biliary obstruction.Gut. 2004; 53: 729-734Crossref PubMed Scopus (505) Google Scholar endoscopic biliary sphinctertomy (EST) or endoscopic papillary balloon dilation (EPBD) were widely used for endoscopic metallic stent placement. Although EST might result in permanent loss of SO function, EPBD is presumed to produce only a transient decrease in SO function that is substantially restored within several months.3Isayama H. Komatsu Y. Inoue Y. et al.Preserved function of the Oddi sphincter after endoscopic papillary balloon dilation.Hepatogastroenterology. 2003; 50: 1787-1791PubMed Google Scholar Loss of SO function might result in reflux of intestinal bacteria along with duodenal food contents into the bile duct. This may play a role in cholangitis or stent occlusion.4Uchida N. Tsutsui K. Ezaki T. et al.Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction.J Gastroenterol. 2005; 40: 291-296Crossref PubMed Scopus (35) Google Scholar, 5Matsushita M. Hajiro K. Takakuwa H. et al.Are biliary stents placed above the sphincter of Oddi really ineffective?.Gastrointest Endosc. 2000; 51: 116-117Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Although 72% of patients underwent stent placement transhepatically in this study, the authors should address the type of intervention (eg, EST or EPBD) on the SO by the endoscopic or even the percutaneous route because this may have a significant impact on poststenting cholangitis or interpretation of results.6Park D.H. Kim M.H. Choi J.S. et al.Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis.Clin Gastroenterol Hepatol. 2006; 4: 790-796Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar In the particular case with stent placement above the main duodenal papilla with EST, we can assume that the risk of the cholangitis after stent placement may increase because of disruption the sphincter mechanism by EST. Therefore, future prospective studies of risk factors for acute cholangitis after metallic biliary stent placement should evaluate not only the placement of a biliary stent metallic stent across the main papilla but also the type of intervention on the SO. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitisGastrointestinal EndoscopyVol. 63Issue 6PreviewCholangitis is a major complication after metallic stent placement to treat biliary obstruction, and it may impair quality of life. Whether transpapillary stent placement contributes cholangitis is still controversial. Full-Text PDF" @default.
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• W2091218084 title "The type of intervention on the sphincter of Oddi is also an important risk factor of cholangitis after metallic biliary stent placement" @default.
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• W2091218084 doi "https://doi.org/10.1016/j.gie.2006.06.050" @default.
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