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


METHODS
Retrospective.


METHODS
Tertiary-care medical center (Charleston, SC).


METHODS
Consecutive patients who received multiple plastic stents for benign nonhilar biliary strictures from 1994 to 2008 were identified.


METHODS
Exchange of multiple plastic biliary stents within 6 months (group 1) or 6 months or longer (group 2) after placement.


METHODS
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).


CONCLUSIONS
Retrospective study at a single tertiary referral center.


CONCLUSIONS
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.
Lawrence
Christopher
C
Medical University of South Carolina, Charleston, South Carolina 29425, USA. lawrench@musc.edu
Romagnuolo
Joseph
J
Payne
K Mark
KM
Hawes
Robert H
RH
Cotton
Peter B
PB
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010969:Plastics; D019233:Retreatment; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents
D010969:Plastics