title: A comparative evaluation of early stent occlusion among biliary conventional versus wing stents.
abstract: OBJECTIVE
  Conventional plastic stents with a lumen typically have limited patency. The lumenless wing stent was engineered to overcome this problem. The objective of this study was to compare the incidence of early stent occlusion (symptomatic occlusion/cholangitis necessitating re-insertion within 90 days) for wing stents and conventional plastic stents.
  
  
  METHODS
  Patients with biliary pathology treated with plastic biliary stenting during the period 2003-2009 comprised the study cohort. Patients who had at least one biliary wing stent placed comprised the wing stent group, whereas patients who underwent only conventional stent plastic placement comprised the conventional stent group. Patients were stratified by indication: benign biliary strictures (group 1), malignant biliary strictures (group 2), or benign biliary non-stricture pathology (group 3). The association of stent type with the occurrence of primary outcome by indication was analyzed by use of multivariable logistic regression.
  
  
  RESULTS
  Three-hundred and forty-six patients underwent 612 ERCP procedures with placement of plastic biliary stent(s). On multivariate analysis, early stent occlusion did not differ between the wing and conventional groups in groups 1, 2, and 3. Among patients who achieved primary outcome in group 2, significantly fewer patients in the wing group had cholangitis (6.7% vs. 39.1%, P = 0.03). Among patients who achieved primary outcome in group 3, significantly fewer patients in the wing group had cholangitis (10% vs. 50%, P = 0.03).
  
  
  CONCLUSIONS
  Early stent occlusion was similar for wing stents and conventional plastic stents. Wing stents, however, were associated with a lower incidence of cholangitis in patients with malignant biliary obstruction and benign non-stricturing biliary pathology.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. mkhasha1@jhmi.edu
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Katherine
authors.initials: K
authors.lastname: Kim
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Marcia I
authors.initials: MI
authors.lastname: Canto
authors.forename: Sanjay B
authors.initials: SB
authors.lastname: Jagannath
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Okolo
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Shin
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome