Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2018; 10(1): 45-50
Published online Jan 16, 2018. doi: 10.4253/wjge.v10.i1.45
Management of endoscopic biliary stenting for choledocholithiasis: Evaluation of stent-exchange intervals
Gen Tohda, Masaki Dochin
Gen Tohda, Masaki Dochin, Department of Gastroenterology, Fukui Kosei Hospital, Fukui 918-8537, Japan
Author contributions: Tohda G wrote the manuscript and analyzed the data; Dochin M reviewed the manuscript.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki, and was reviewed ethically and approved by the Fukui Kosei Hospital Institutional Review Board.
Informed consent statement: All patients involved in this study gave their written informed consent about disclosure of their protected medical information.
Conflict-of-interest statement: Authors declare no conflict of interest relevant to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gen Tohda, MD, PhD, Chief Doctor, Department of Gastroenterology, Fukui Kosei Hospital, Shimo-rokujyo 201, Fukui 918-8537, Japan. gtoda@koseikaigroup.jp
Telephone: +81-776-413377 Fax: +81-776-413372
Received: October 15, 2017
Peer-review started: October 24, 2017
First decision: November 23, 2017
Revised: November 30, 2017
Accepted: December 6, 2017
Article in press: December 7, 2017
Published online: January 16, 2018
Processing time: 84 Days and 1.7 Hours
Abstract
AIM

To evaluate the best management of plastic stents in patients with choledocholithiasis who were unfit for endoscopic stone removal or surgery.

METHODS

Between April 2007 and September 2017, 87 patients (median age 83.7 years) with symptomatic choledocholithiasis were treated with insertion of 7-Fr plastic stents because complete endoscopic stone retrieval was difficult, and their general condition was not suitable for surgery. Seventy of these patients agreed to regular stent management and stent exchange was carried out at every 6 mo (Group A, n = 35) or every 12 mo (Group B, n = 35). The remaining 17 patients did not accept regular stent exchange, and stents were replaced when clinical symptoms appeared (Group C). We evaluated the frequency of biliary complication and stent patency rate during follow-up periods.

RESULTS

The patency rate of biliary plastic stents was 91.4% at 6 mo (Group A) and 88.6% at 12 mo (Group B), respectively. Acute cholangitis occurred in 2.9% of Group A patients and in 8.6% of Group B patients. In Group C, median stent patency was 16.3 mo, and stent exchange was carried out in 70.6% of cases because of acute cholangitis or obstructive jaundice. Although a high incidence of acute cholangitis occurred, there was no biliary-related mortality.

CONCLUSION

Plastic stent exchange at 12-mo intervals is considered a safe procedure for patients with choledocholithiasis. Long-term biliary stenting increases biliary complications, but it can be an acceptable option for select patients who are medically unfit for further invasive procedures.

Keywords: Acute cholangitis; Endoscopic retrograde cholangiopancreatography; Stent exchange; Plastic stent; Biliary stenting

Core tip: Adequate management of plastic stents for choledocholithiasis was evaluated. Stent exchange was carried out at every 6 mo (Group A), every 12 mo (Group B) or on demand (Group C). The stent patency rates were 91.4% for Group A and 88.6% for Group B, respectively. In Group C, median stent patency was 16.3 mo, and stent exchange was required in 70.6% of patients. There was no biliary-related mortality. Although 12 mo is considered a safe interval for plastic stent exchange, long-term biliary stenting can be an acceptable option for selected patients who are medically unfit for further invasive procedures.