title: Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study.
abstract: BACKGROUND
  Plastic and covered metal stents need to be removed or exchanged within appropriate time in case of undesirable complications. However, it is not uncommon that patients do not follow the recommendation for further stent management after Endoscopic Retrograde Cholangiopancreatography (ERCP). The effect of short message service (SMS) intervention monthly on the stent removal/exchange adherence in patients after ERCP is unknown at this time.
  
  
  METHODS
  A prospective, randomized controlled study was conducted. After receiving regular instructions, patients were randomly assigned to receive SMS reminding monthly (SMS group) for stent removal/exchange or not (control group). The primary outcome was stent removal/exchange adherence within appropriate time (4 months for plastic stent or 7 months for covered stent). Multivariate analysis was performed to assess factors associated with stent removal/exchange adherence within appropriate time. Intention-to-treat analysis was used.
  
  
  RESULTS
  A total of 48 patients were randomized, 23 to the SMS group and 25 to the control. Adherence to stent removal/exchange was reported in 78.2 % (18/23) of patients receiving the SMS intervention compared with 40 % (10/25) in the control group (RR 1.98, 95 % CI 1.16-3.31; p = 0 · 010). Among patients with plastic stent insertion, the median interval time from stent implantation to stent removal/exchange were 90 days in the SMS group and 136 days in the control respectively (HR 0.36, 95 % CI 0.16-0.84, p = 0.018). No difference was found between the two groups regarding late-stage stent-related complications. The rate of recurrent abdominal pain tended to be lower in SMS group without significant difference (8.7 vs 28 %, p = 0.144). Multivariate logistic regression analyses revealed that SMS reminding was the only factor associated with adherence of stent removal/exchange (OR 6.73, 95 % CI 1.64-27.54, p = 0.008).
  
  
  CONCLUSIONS
  This first effectiveness trial demonstrated that SMS reminding monthly could significantly increase the patient adherence to stent removal/exchange after ERCP.
  
  
  BACKGROUND
  The study was respectively registered on July 10 in 2016 at ClinicalTrials.gov ( NCT02831127 ).
authors: Department of Gastroenterology, the first affiliated hospital of Xi'an Jiao Tong university, Xi'an, China.|Digestive System Department, Shaanxi Provincial Crops Hospital of Chinese People's Armed Police Force, Xi'an, China.
authors: Yong
authors: Y
authors: Gu
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Limei
authors: L
authors: Wang
authors: Department of Radiotherapy, Xijing Hospital, Xian, China.
authors: Lina
authors: L
authors: Zhao
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Zhiguo
authors: Z
authors: Liu
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Hui
authors: H
authors: Luo
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Qin
authors: Q
authors: Tao
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Rongchun
authors: R
authors: Zhang
authors: Department of Gastroenterology, the first affiliated hospital of Xi'an Jiao Tong university, Xi'an, China.
authors: Shuixiang
authors: S
authors: He
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Xiangping
authors: X
authors: Wang
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Rui
authors: R
authors: Huang
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
authors: Linhui
authors: L
authors: Zhang
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China. panyanglin@gmail.com.
authors: Yanglin
authors: Y
authors: Pan
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China. xuegangguo@gmail.com.
authors: Xuegang
authors: X
authors: Guo
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000523:psychology* / Q000601:surgery; D040421:Cell Phone; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010182:Pancreatic Diseases / Q000523:psychology* / Q000601:surgery; D010349:Patient Compliance; D011182:Postoperative Care / Q000379:methods / Q000523:psychology*; D011446:Prospective Studies; D015607:Stents / Q000523:psychology*; D060145:Text Messaging; D013997:Time Factors
keywords: Adherence; Biliary stricture; ERCP; Short message service; Stent exchange