Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals

• Published in: Gastrointestinal endoscopy Vol. 72; no. 3; pp. 558 - 563
• Main Authors: Lawrence, Christopher, MD, Romagnuolo, Joseph, MD, FRCPC, MSc(Epid), Payne, K. Mark, MD, Hawes, Robert H., MD, Cotton, Peter B., MD, FRCP, FRCS
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-09-2010; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Extrahepatic - etiology; Cholestasis, Extrahepatic - therapy; Digestive system. Abdomen; Diseases of mother, fetus and pregnancy; Endoscopy; Equipment Failure Analysis; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Plastics; Pregnancy. Fetus. Placenta; Retreatment; Retrospective Studies; Secondary Prevention; Stents; Benign biliary stricture; BBS; Occlusion; Premature; Symptomatology; Multiple; Instrumentation therapy; Digestive diseases; Biliary tract disease; Biliary tract obstruction; Stent
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.05.029

Background Benign biliary strictures are typically managed endoscopically whereby an increasing size or number of plastic stents is placed at ERCP. Stents are often changed every 3 to 4 months based on the known median patency of a single biliary stent, but patency data for multiple biliary stents are lacking. Objective To assess the incidence of occlusion-free survival of multiple plastic biliary stents and the rate of premature occlusion if left in longer than 6 months. Design Retrospective. Setting Tertiary-care medical center (Charleston, SC). Patients Consecutive patients who received multiple plastic stents for benign nonhilar biliary strictures from 1994 to 2008 were identified. Interventions Exchange of multiple plastic biliary stents within 6 months (group 1) or 6 months or longer (group 2) after placement. Main Outcome Measurements Symptomatic stent occlusion. Results Seventy-nine patients with nonhilar extrahepatic benign biliary stricture underwent 125 ERCPs with multiple plastic biliary stents. Stents were scheduled for removal/exchange within 6 months in 52 patients (86 ERCPs) compared with after 6 months in 22 patients (26 ERCPs). The median interval between multiple stent placement and removal/exchange was 90 days for group 1 and 242 days for group 2. Premature stent occlusion occurred in 4 of 52 (7.7%) patients in group 1 versus 1 of 22 (4.5%) in group 2, with significantly longer occlusion-free survival in group 2 (log-rank P < .0001). Limitations Retrospective study at a single tertiary referral center. Conclusion Multiple plastic biliary stents for benign nonhilar strictures were associated with a low rate of premature symptomatic stent occlusion at more than 6 months and a longer occlusion-free survival.