Repeat Procedures Within 30 days in Patients Stented for Malignant Distal Biliary Strictures: Experience of 508 Patients at a Tertiary Referral Center.

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2012-04

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Abstract

BACKGROUND: Stent related occlusion and migration remains a problem despite attempts to improve stent design over this time period. Flanged polyethylene plastic stents (FPS) remains the stent of choice in most centers. Early failure of stents placed for malignant extrahepatic biliary strictures (MEBS) has not previously been studied in detail. We set out to determine the incidence and reasons for biliary stent change within 30 days of the index procedure in a large tertiary center population during a period where (FPS) was the sole plastic stent used. METHODS: Retrospective analysis of endoscopic retrograde cholangiography (ERCP) was undertaken in patients who were stented for presumed or known MEBS between 1993 and 2001. Patients who required repeat stenting within 30 days were identified. RESULTS: All 508 patients were stented for MEBS. 5.7% of patients had a total of 34 repeat stenting procedures within 30 days of the index procedure; 27of 29 index stents were plastic, 2 were self-expandable metal stents (SEMS), 20 (3.9%) patients had stent failure as the reason for a stent exchange (plastic stent occlusion n = 15, mean time to stent change 14 ± 8.3 days; metal stent occlusion n = 2, mean time to stent change 24.5 ± 7.8 days; plastic stent migration n = 3, mean time to stent change 25 ± 5.3 days). There was a statistically significant difference in the time to stent change between the occluded plastic stent and migrated plastic stent cases (P = 0.045, 95% CI -21.7 to -0.29). 6 patients spent at least 2 additional days in hospital as a result of stent failure. CONCLUSIONS: Early stent failure is an uncommon problem, especially in patients with SEMS. Early plastic stent failure appears to occur sooner with stent occlusion than with stent migration. Early stent failure is associated with significant morbidity and bears an economic impact in additional procedures and hospital stay.

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10.4021/gr420w

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Byrne, Michael F, Calvin Hy Chan, Malcolm S Branch, Paul S Jowell and John Baillie (2012). Repeat Procedures Within 30 days in Patients Stented for Malignant Distal Biliary Strictures: Experience of 508 Patients at a Tertiary Referral Center. Gastroenterology Res, 5(2). pp. 57–62. 10.4021/gr420w Retrieved from https://hdl.handle.net/10161/13064.

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Branch

Malcolm Stanley Branch

Professor of Medicine

The general focus of my work is related to endoscopic diagnosis and treatment of clinically important biliary and pancreatic disorders. This would include pancreatitis and pancreatic and biliary malignancies. I have recently been involved in investigation of new techniques for diagnosis and palliation of GI malignancies. Other areas of interest are in therapeutic endoscopy and its development as well as new imaging techniques for endoscopy.

I am also recognized in the area of endoscopy unit management and quality assurance.

Key words: pancreas disorders, pancreatitis, pancreatic cancer, bile duct disorders, bile duct malignancies, ERCP, choledochoscopy, colorectal and esophageal cancer.


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