Premium
Outcomes of preoperative biliary drainage from a single tertiary center: I s there still a role for plastic stents?
Author(s) -
Ma Michael Xiang,
Chin Marcus Woon Soon,
Jennings Melissa,
Siah Chiang,
Edmunds Simon
Publication year - 2017
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12455
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , surgery , cholestasis , stent , complication , single center , biliary drainage , biliary stent , confidence interval , percutaneous , bilirubin , gastroenterology , pancreatitis
OBJECTIVES Preoperative biliary drainage ( PBD ) can relieve symptoms of cholestasis, but carries risk of procedural complications. Metal stents have wider lumens and longer patency, although plastic stents ( PS ) remain in use. We reviewed the outcomes after PBD in patients with cholestasis. METHODS Patients with symptomatic cholestasis who were likely to wait for over 2 weeks before surgery and were thus treated with PBD between J anuary 2011 and M ay 2015 were included. Patients were evaluated for stenting‐related complications, time interval to surgery, resection rate, improvement in bilirubin level and surgical complications. RESULTS Forty patients underwent PBD by endoscopic retrograde cholangiopancreatography (ERCP) . Of these, 36 patients received the placement of PS , one received a metal stent and the remaining three required percutaneous drainage due to unsuccessful biliary cannulation. Serum bilirubin declined from 172 μmol/L (baseline) to 14 μmol/L at 30 days ( P < 0.0001). Median time interval from ERCP to surgery in all patients was 5 weeks (range 2–36 weeks). Preoperative stenting‐related complications occurred in seven patients after a median of 3 weeks (range 1–6 weeks). Median time to surgery was similar in patients with and without stenting‐related complications (5 weeks vs 4 weeks, respectively, P = 0.33). Surgery was completed in 32 (80%) patients, with a post‐ W hipple complication rate of 53%. CONCLUSIONS PBD using mostly PS was effective in reducing bilirubin levels and did not detrimentally affect time interval to surgery. Median time interval to stenting‐related complication occurred after 3 weeks, suggesting PS may be most useful for short‐term PBD .