Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 622-628
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.622
Complications and management of forgotten long-term biliary stents
Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim
Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
Author contributions: All the authors contributed equally to the study conception and design, performance of the data collection, analysis and interpretation, performance of the statistical analysis, and drafting and revising of the manuscript.
Supported by 2015 Yeungnam University Research Grant, No. 215A380205.
Institutional review board statement: This study was approved by the Institutional Review Board of Yeungnam University Hospital (IRB number: 2015-04-001).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: No potential conflict of interest relevant to this article was reported.
Data sharing statement: The original anonymized dataset is available on request from the corresponding author at tnkim@yu.ac.kr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tae Nyeun Kim, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, South Korea. tnkim@yu.ac.kr
Telephone: +82-53-6203842 Fax: +82-53-6548386
Received: November 9, 2016
Peer-review started: November 11, 2016
First decision: December 2, 2016
Revised: December 16, 2016
Accepted: December 21, 2016
Article in press: December 21, 2016
Published online: January 28, 2017
Processing time: 70 Days and 20.2 Hours
Abstract
AIM

To evaluate complications and management outcomes of retained long-term plastic biliary stents.

METHODS

Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher’s exact test and χ2 tests. Statistical significance was defined as P < 0.05 (two-tailed).

RESULTS

Mean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents.

CONCLUSION

The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.

Keywords: Biliary stent; Long-term complications; Forgotten stents; Acute cholangitis; Biliary stone

Core tip: There is little information on the consequence of retained long-term biliary stents and management of complications. In this study, follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients and cholangitis due to common bile duct stones or sludge developed in most cases (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases.