Abstract
In endoscopic biliary drainage (EBD) for various benign and malignant biliary disorders, the appropriate timing to replace or change a plastic stent (PS) with a self-expandable metallic stent (SEMS) remains unclear. This study aimed to define the best period to replace or change a PS with a SEMS. Between January 1, 2012, and December 31, 2018, 1,887 consecutive EBD procedures, including 170 SEMS placements, were retrospectively identified. The period to recurrent biliary obstruction (PRBO) was estimated and compared between the malignant and benign groups and according to each disease using time to event analysis and competing risk analysis. Compared with the benign group, the malignant group had significantly shorter median PRBO with interquartile range (IQR) after PS placement [108 (39 – 270) vs. 613 (191 – 1,329) days, P < 0.001], even on multivariate analysis, with a subdistribution hazard ratio (SHR) of 3.58 (P < 0.001). The shortest PRBO distribution from the first quartile of the non-RBO period was seen in Mirizzi syndrome cases (25 days, P = 0.030, SHR = 3.32) in the benign group and in cases of pancreatic cancer (32 days, P = 0.041, SHR = 2.06); perihilar bile duct cancer (27 days, P = 0.006, SHR = 2.69); and ampullary cancer (22 days, P = 0.001, SHR = 3.78) in the malignant group. Our study supports that stent replacement for the benign group is feasible after 6 months, and the best period to replace or change a PS with a SEMS should be decided on the basis of the underlying disease to prevent RBO.
Highlights
In endoscopic biliary drainage (EBD) for various benign and malignant biliary disorders, the appropriate timing to replace or change a plastic stent (PS) with a self-expandable metallic stent (SEMS) remains unclear
In the setting of a retrospective continuous series, 1,887 eligible patients who underwent EBD procedures using PSs or SEMSs were enrolled in the present study (Fig. 1 and Table 1)
The proportion of cases with acute cholangitis at the initial EBD was significantly higher in the malignant group than in the benign group (54.7% vs. 48.8%, P = 0.04)
Summary
In endoscopic biliary drainage (EBD) for various benign and malignant biliary disorders, the appropriate timing to replace or change a plastic stent (PS) with a self-expandable metallic stent (SEMS) remains unclear. The period to recurrent biliary obstruction (PRBO) was estimated and compared between the malignant and benign groups and according to each disease using time to event analysis and competing risk analysis. Up to the present time, the recommended period for PS replacement in malignant cases has been 3−6 months, based on studies that evaluated and compared the period to RBO (PRBO) between PS and S EMS13,16 Despite this recommendation, the actual period to recurrent biliary obstruction (PRBO) frequently seemed to be shorter in daily medical practice. Because few studies on PS have reported details on the suitable interval or timing of replacement or change to SEMS according to the risk factors for RBO in each biliary disorder, the actual PRBO is not known in Scientific Reports | (2020) 10:13080. The primary aim of this study was to define the best period to replace or change a PS with a SEMS in each disease, after resolving the risk factors for RBO
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