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Role of long‐term biliary stenting in choledocholithiasis
Author(s) -
Slattery Eoin,
Kale Vikrant,
Anwar Waqas,
Courtney Garry,
Aftab Abdur R
Publication year - 2013
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2012.01399.x
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , stent , interquartile range , biliary stent , surgery , jaundice , incidence (geometry) , obstructive jaundice , radiology , pancreatitis , physics , optics
Background and Aim Endoscopic retrograde cholangiopancreatography ( ERCP ) is the treatment of choice for the management of choledocholithiasis. Biliary stenting facilitates repeated attempts at stone extraction. The aim of the present paper was to assess long‐term outcomes of patients where biliary stenting was used as the primary treatment for the management of choledocholithiasis. Methods We undertook a review of a prospectively maintained database of all ERCP carried out at a single institution. All patients had stones not amenable to endoscopic retrieval. Results Between J anuary 1998 and D ecember 2008, 3655 ERCP were carried out in our unit. Of these, 201 (120 female) patients met our inclusion criteria. All patients underwent ERCP and sphincterotomy, followed by insertion of a double pigtail 7‐ F r plastic stent. Repeat ERCP was not scheduled routinely. Stent change was only carried out in patients when clinical suspicion of stent blockage occurred. Median stent patency was 59.6 months (interquartile range 47.7–71.2). At 6 months, stent patency was 93.5%, and at 24 months, it was 81.9%. Serious adverse outcomes with blocked stents were uncommon, and tended to occur early. Cholangitis was seen in only 7.4% (6) of patients (median stent patency 11.8 months) and jaundice was seen in 18.5% (15 patients, median stent patency 7.2 months). Conclusion Our data demonstrate median stent patency of almost 5 years. The low incidence of significant complications with blocked stents and excellent stent patency rates suggest that long‐term biliary stenting is an acceptable alternative in elderly, frail patients with stones that are not endoscopically retrievable.