title: Outcomes of preoperative biliary drainage from a single tertiary center: Is there still a role for plastic stents?
abstract: OBJECTIVE
  Preoperative biliary drainage (PBD) can relieve symptoms of cholestasis, but carries risk of procedural complications. Metal stents have wider lumens and longer patency, although plastic stents (PS) remain in use. We reviewed the outcomes after PBD in patients with cholestasis.
  
  
  METHODS
  Patients with symptomatic cholestasis who were likely to wait for over 2 weeks before surgery and were thus treated with PBD between January 2011 and May 2015 were included. Patients were evaluated for stenting-related complications, time interval to surgery, resection rate, improvement in bilirubin level and surgical complications.
  
  
  RESULTS
  Forty patients underwent PBD by endoscopic retrograde cholangiopancreatography (ERCP). Of these, 36 patients received the placement of PS, one received a metal stent and the remaining three required percutaneous drainage due to unsuccessful biliary cannulation. Serum bilirubin declined from 172 μmol/L (baseline) to 14 μmol/L at 30 days (P < 0.0001). Median time interval from ERCP to surgery in all patients was 5 weeks (range 2-36 weeks). Preoperative stenting-related complications occurred in seven patients after a median of 3 weeks (range 1-6 weeks). Median time to surgery was similar in patients with and without stenting-related complications (5 weeks vs 4 weeks, respectively, P = 0.33). Surgery was completed in 32 (80%) patients, with a post-Whipple complication rate of 53%.
  
  
  CONCLUSIONS
  PBD using mostly PS was effective in reducing bilirubin levels and did not detrimentally affect time interval to surgery. Median time interval to stenting-related complication occurred after 3 weeks, suggesting PS may be most useful for short-term PBD.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Michael Xiang
authors.initials: MX
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Marcus Woon Soon
authors.initials: MWS
authors.lastname: Chin
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jennings
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Chiang
authors.initials: C
authors.lastname: Siah
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Edmunds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004067:Digestive System Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010969:Plastics; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods; D057234:Preoperative Period; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010969:Plastics
keywords: drainage; endoscopic retrograde cholangiopancreatography; metal stent; pancreaticobiliary malignancy; pancreaticoduodenectomy; plastic stent