Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: an analysis using a time-dependent covariate.
BACKGROUND
Although the combination of biliary and duodenal self-expandable metal stents (SEMS) is useful, the exacerbating effect of duodenal SEMS placement on biliary SEMS has not been documented. We conducted a multicenter retrospective study to evaluate the effect of duodenal SEMS placement on biliary SEMS.


METHODS
Patients who underwent first-time biliary SEMS placement for a distal malignant biliary obstruction between September 1994 and November 2010 were included. Time to dysfunction of biliary SEMS was analyzed to identify risk factors for biliary SEMS dysfunction. Duodenal SEMS placement was analyzed as a time-dependent covariate.


RESULTS
In total, 410 eligible patients were identified. Duodenal SEMS were placed in 33 patients (8 %). The median time to dysfunction of biliary SEMS was 170 days. Male gender (hazard ratio 1.37, 95 % confidence interval 1.03-1.83, P = 0.029) and duodenal SEMS placement (hazard ratio 2.00, 95 % confidence interval 1.16-3.45, P = 0.013) were risk factors in the multivariate Cox model. In patients undergoing duodenal SEMS, biliary SEMS dysfunction was observed in 17 (52 %) with a median time to dysfunction of 64 days after duodenal SEMS placement. As many as 60 % of the patients with biliary SEMS dysfunction after duodenal SEMS placement needed permanent percutaneous transhepatic biliary external drainage.


CONCLUSIONS
Duodenal SEMS placement is a risk factor for biliary SEMS dysfunction. Alternative methods for biliary drainage should be considered for better biliary drainage in patients with a gastric outlet obstruction.
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan. hamada-tky@umin.ac.jp
Tsuyoshi
T
Hamada
Yousuke
Y
Nakai
Hiroyuki
H
Isayama
Takashi
T
Sasaki
Hirofumi
H
Kogure
Kazumichi
K
Kawakubo
Naoki
N
Sasahira
Natsuyo
N
Yamamoto
Osamu
O
Togawa
Suguru
S
Mizuno
Yukiko
Y
Ito
Kenji
K
Hirano
Nobuo
N
Toda
Minoru
M
Tada
Kazuhiko
K
Koike
D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors