Repeat Procedures Within 30 days in Patients Stented for Malignant Distal Biliary Strictures: Experience of 508 Patients at a Tertiary Referral Center.
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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https://hdl.handle.net/10161/13064Published Version (Please cite this version)
10.4021/gr420wPublication Info
Byrne, Michael F; Chan, Calvin Hy; Branch, Malcolm S; Jowell, Paul S; & Baillie, John (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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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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 endosc

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