Does Endoscopic Sphincterotomy Improve Plastic Biliary Stent Patency in Benign Biliary Strictures? A Comparative Analysis

Abstract

Objective: To evaluate whether endoscopic sphincterotomy improves plastic biliary stent patency compared with stent placement without sphincterotomy.

Study design: Prospective cohort study.

Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from Oct 2025 to Mar 2026.

Methodology: This study enrolled adult patients with benign biliary strictures undergoing either elective or emergency Endoscopic Retrograde Cholangiopancreatography (ERCP).

Results: A total of 292 patients with benign biliary strictures were enrolled in the study, with 146 patients allocated to the sphincterotomy group (Group-A) and 146 patients to the non-sphincterotomy group (Group-B). Successful stent insertion was achieved in 92.5% of patients in the Group-A and 89.0% in the Group-B. Early complications were uncommon; post-ERCP pancreatitis occurred in 13.7% and 16.4% of patients, respectively, while bleeding was observed only in the Group-A (6.8%). Late complications, including cholangitis due to stent occlusion and stent migration, occurred at comparable rates in both groups. Median stent patency was similar between the Group-A and Group-B (110 ± 12 vs 111 ± 18 days). Successful stent replacement during follow-up was achieved in the majority of patients, with no significant difference between groups.

Conclusion: Routine Endoscopic sphincterotomy (ES) does not significantly improve plastic biliary stent patency and should not be performed solely for this purpose.