title: Complications and management of forgotten long-term biliary stents.
abstract: OBJECTIVE
  To evaluate complications and management outcomes of retained long-term plastic biliary stents.
  
  
  METHODS
  Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using thettest. Observed frequencies in subsets of the study population were compared using Fisher's exact test and χ2tests. Statistical significance was defined asP< 0.05 (two-tailed).
  
  
  RESULTS
  Mean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 movsover 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents.
  
  
  CONCLUSIONS
  The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.
authors.affiliation: Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Sohn
authors.affiliation: Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea.
authors.forename: Kook Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Se Hoon Sohn, Jae Hyun Park, Kook Hyun Kim, Tae Nyeun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea.
authors.forename: Tae Nyeun
authors.initials: TN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000209:etiology; D002779:Cholestasis / Q000209:etiology; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects*
keywords: Acute cholangitis; Biliary stent; Biliary stone; Forgotten stents; Long-term complications