An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital.
BACKGROUND
This study audited the clinical outcome of a cohort of patients with choledocholithiasis treated with long-term biliary stenting in order to determine the feasibility of this practice.


METHODS
Over 2 years, 83 patients with symptomatic choledocholithiasis were treated with long-term stenting because they either refused further treatments or were medically unfit for further procedures after the initial endoscopic retrograde cholangiopancreatography (ERCP). Recurrence of clinical events, need for stent change, morbidity, and mortality were analyzed. As a secondary analysis, published data on long-term biliary stenting were reviewed.


RESULTS
ERCP and biliary stenting were successful in all cases with no complications. The mean follow-up was 19 months (1-103 months). The median number of ERCPs performed was 1 (1-4). The mean duration of stent patency was 12.4 months (1-54.8 months). A total of 28 clinical events (cholangitis, 71%) occurred in 24 patients during follow-up, for a late complication rate of 33.7%. ERCP was repeated and the stents changed on 15 occasions in 11 asymptomatic patients with abnormal liver function tests detected on routine follow-up. No biliary-related mortality occurred. Review of published data revealed a mean late complication rate of 22.4% (0%-64%), a biliary-related mortality rate of 3.5% (0%-21.1%), and a nonbiliary-related mortality rate of 20.8% (0%-60.3%).


CONCLUSIONS
Long-term biliary stenting is a feasible option for patients who decline or are medically unfit for further elective endoscopic or surgical procedures. Close follow-up is mandatory to detect and treat late complications.
Ang
Tiing Leong
TL
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore 529889, Singapore.
Fock
Kwong Ming
KM
Teo
Eng Kiong
EK
Chua
Tju Siang
TS
Tan
Jessica
J
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D016312:Treatment Refusal