title: Predictors of early stent occlusion among plastic biliary stents.
abstract: OBJECTIVE
  A major disadvantage of plastic biliary stents is their short patency rates. The aim of this study was to identify predictors of early stent occlusion among patients receiving conventional plastic biliary stents.
  
  
  METHODS
  Early stent occlusion was defined as worsening cholestatic liver test results of a severity sufficiently significant to warrant ERCP with stent exchange prior to the planned stent exchange, or as symptoms of cholangitis. The association of cumulative stent diameter, demographics, stricture location, procedure indication, Charlson comorbidity index, history of prior early stent occlusion, presence of gallbladder, and performance of sphincteromy with the occurrence of early stent occlusion was studied using logistic regression and multivariate analysis.
  
  
  RESULTS
  Our patient cohort comprised 343 patients (mean age 59.3 years) who underwent 561 ERCP procedures with the placement of one or more plastic biliary stents (mean number of stents per procedure 1.2, mean total diameter of stents per procedure 12 Fr). Early stent occlusion occurred in 73 (13 %) procedures. Female gender was protective against early stent occlusion (adjusted OR 0.54, 95 % CI 0.32-0.90, p = 0.02), while hilar stricture location was independently associated with a significantly increased risk of early stent occlusion (adjusted OR 3.41, 95 % CI 1.68-6.90, p = 0.0007).
  
  
  CONCLUSIONS
  Early occlusion of conventional biliary stents occurred in 13 % of cases. While female gender decreased the risk of early stent occlusion, hilar stricture location was a significant predictor of early stent occlusion. Our results suggest that physicians should consider early elective stent exchange in patients with hilar strictures.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room 426, Baltimore, MD 21205, USA. mkhasha1@jhmi.edu
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Katherine
authors.initials: K
authors.lastname: Kim
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010969:Plastics; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D010969:Plastics