Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2019; 11(5): 365-372
Published online May 16, 2019. doi: 10.4253/wjge.v11.i5.365
Should a fully covered self-expandable biliary metal stent be anchored with a double-pigtail plastic stent? A retrospective study
Saad Emhmed Ali, Wesam M Frandah, Leon Su, Cory Fielding, Houssam Mardini
Saad Emhmed Ali, Department of Internal Medicine, Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States
Wesam M Frandah, Cory Fielding, Houssam Mardini, Department of Internal Medicine, Division of Gastroenterology, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States
Leon Su, Department of Statistics, College of Arts and Sciences, College of Public Health, University of Kentucky, Lexington, KY 40536, United States
Author contributions: Saad Emhmed Ali, Mardini H, Frandah WM and Cory Fielding C made the study design, data collection, and script preparation. Su L and Mardini H made the data analysis. Emhmed Ali SM, Frandah WM and Mardini H wrote the manuscript. Mardini H and Frandah WM was the reviewers of the paper.
Institutional review board statement: This study was approved by the Ethics Committee of the University of Kentucky Medical Center, No: 17-0287-X6B.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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/
Corresponding author: Saad Emhmed Ali, MD, Assistant Professor, Internal Medicine Physician, Department of Internal Medicine, Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky, 800 Rose St, Lexington, KY 40536, United States. saad.ali@uky.edu
Telephone: +1-859-2184991 Fax: +1-859-2283352
Received: March 6, 2019
Peer-review started: March 8, 2019
First decision: April 13, 2019
Revised: April 30, 2019
Accepted: May 10, 2019
Article in press: May 11, 2019
Published online: May 16, 2019
Processing time: 72 Days and 21.6 Hours
Abstract
BACKGROUND

The migration rate of fully covered self-expandable metal stents (FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a double-pigtail plastic stent (DPS) may decrease migration.

AIM

To compare stent migration rates between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS.

METHODS

We conducted a retrospective analysis of endoscopy reporting system and medical records of 1366 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement at the University of Kentucky health care. Between July 2015 and April 2017, 203 patients with FCSEMS insertion for the treatment of malignant biliary stricture, benign biliary stricture, post-sphincterotomy bleeding, bile leak, and cholangitis drainage were identified. The review and analysis were conducted through our endoscopy reporting system (ProVation® MD) and medical records. Categorical data were analyzed using Chi-Square and Fischer exact test and continuous data using non-parametric tests. A regression analysis was performed to identify factors independently associated with increased risk of stent migration. We determined an FCSEMS migration endoscopically if the stent was no longer visible in the major papilla.

RESULTS

1366 patients had undergone ERCP by three advanced endoscopists over 21-mo period; among these, 203 patients had FCSEMSs placed. 65 patients had FCSEMSs with DPS, and 138 had FCSEMSs alone. 65 patients had FCSEMSs with DPS, and 138 had FCSEMSs alone. 95 patients had a malignant stricture, 82 patients had a benign stricture, 12 patients had bile leak, 12 patients had cholangitis, and nine patients had post-sphincterotomy bleeding. The migration rate in patients with anchored FCSEMSs with DPS was 6%, and those without anchoring DPS was 10% (P = 0.35). Overall, migration was reported in 18 patients with FCSEMSs placement out of 203 patients with an overall migration rate of 9.7%. There was no significant association between anchoring the FCSEMSs with DPS and the risk of stent migration. Only patients with the previous sphincterotomy and begin biliary stricture were found to have a statistically significant difference in the migration rate between patients who had FCSEMS with DPS and FCSEMS alone (P = 0.01).

CONCLUSION

The risk of migration of biliary FCSEMS was 9.7 %. Anchoring an FCSEMS with DPS does not decrease the risk of stent migration.

Keywords: Metal stents; Double-pigtail plastic stent; Endoscopic retrograde cholangiopancreatography; Biliary drainage; Biliary obstruction

Core tip: In this study, we conducted a retrospective analysis to evaluate the efficacy of 7-French (Fr) and 10-Fr double-pigtail plastic stent (DPS) within the fully covered self-expandable metal stent (FCSEMS) as an anti-migration technique. We compared the rate of stent migration between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS in a large patient population with both benign and malignant strictures as well as non-stricture etiologies. Our findings suggest that anchoring of FCSEMS with a 7-Fr or 10-Fr DPS does not decrease the risk of stent migration. Only benign biliary stricture and previous sphincterotomy were to have a significant association with stent migrations (P = 0.01). We did not find evidence to support the routine placement of anchoring DPS.