Clinical impact of delayed plastic biliary stent removal because of the COVID-19 pandemic: the experience from a tertiary ERCP referral center

Abstract

Background and AimsPlastic biliary endoprosthesis is widely used due to its high efficacy and low cost. Delays in the removal or exchange of plastic biliary stents may lead to stent occlusion and subsequent sepsis [1,2], with consensus recommendation of stent removal or exchange within three-months [3-7]. We postulated that Delayed Plastic Biliary Stent Removal (DPBSR) observed during the pandemic would increase stent-related adverse events. We aim to report our single-center experience with adverse events arising from DPBSR. MethodsAll subjects who had ERCP-guided plastic biliary stent placement in QEII hospital Halifax, Nova Scotia between Dec 2019 and March 2022 were included. Stent lifespan is defined as days between stent deployment and removal. Kaplan-Meier survival analysis was used to represent duration of stent patency. Only 10 French diameter stents were studied. Linear regression was used to analyze possible predictors of stent-related complications. ResultsIn total, 286 cases were analyzed, of which 187 had delayed stent removal. 216 stents were removed without complication, 21 required urgent reintervention for adverse events, 26 died due to non-stent related causes. 21 stents had fully migrated out without causing complications. There was no difference in overall adverse events between the non-delayed vs delayed groups (23.2% vs 21.4%, OR 0.899). Stent AE and emergent removal was marginally increased at OR 1.21 and OR 1.18 in indications related to stone disease. ConclusionsA significant increase was not observed in stent-related complications in subjects with stents removed after 90 days. Plastic biliary stent longevity may be longer than previously thought. Our findings suggest majority of inserted plastic biliary stents remain patent up to 6 months without adverse outcomes.Larger studies are required to better characterize other predictors of biliary stent obstruction.