Mo1376 Biliary Endoprosthesis: a Retrospective Analysis of Biliary Stent Related Late Complications

Abstract

Mo1376 Biliary Endoprosthesis: a Retrospective Analysis of Biliary Stent Related Late Complications Marie Ooi*, Santosh Sanagapalli, Ken Liu, Gavin Barr, James L. Cowlishaw, Rupert W. Leong, Peter Katelaris Gastroenterology, Concord Hospital, Sydney, NSW, Australia Biliary endoprosthesis: Biliary endoprosthesis: A retrospective analysis of biliary stent related late complications. Background: Biliary sepsis may occur following placement of biliary stents either due to stent dysfunction or delay in scheduled interval stent exchange. Causes of stent dysfunction include stent occlusion by debris or tumour ingrowth, stentmigration and stent fracture. Thechoice of stent typedependson the life expectancy of the patient. According to the European Society of Gastroenterology guidelines, plastic stents are cost effective if estimated life expectancy is!4 months while self-expandable metallic stents (SEMS) are preferred if life expectancy exceeds 4 months.Aims: Toassess the frequency and causesof late (after 30days) complications of biliary stenting. Methods: We retrospectively analysed patients presenting with complications related to biliary stents over a 4-year period (Jan 2010-Dec 2013). Data collected included demographics, co-morbidities, indication for stent insertion and stent type(s). Primary outcome was stent related complications. Results: Of 699 patients who had ERCP (58% female, median age 73 yr ; interquartile age range 67-78 yr), 269 had biliary stents inserted, 141 for malignant biliary strictures (Group 1) and 128 for benign biliary disease (Group 2). In Group 1, 118 (84%) had initial palliation of biliary obstruction with a plastic stent while 23 (16%) had a SEMS. In Group 2, a majority (nZ118, 92%) had plastic stents and 10 (8%) had a SEMS. A total of 68 patients (25%) had stent related complications, of which 58 (22%) presented with obstructive jaundice or cholangitis due to occluded stents (13.5 2.9 stents/ yr). Other complications included cholecystitis (nZ3), liver abscess (nZ1), stent migration (nZ5), and stent fracture (nZ1). In Group 1, plastic stents had an OR 4.3 (95% CI 1.85-10.02; p!0.01) for stent occlusion compared to SEMS. In malignant biliary strictures, the time to stent occlusion for plastic, bare metal stents and covered metal stents were 2.1, 6.6 and 11.9 months, respectively. For Group 2, all 23 occluded stents occurred with plastic stents in patients lost to follow up with a mean stent patency of 24.9 months, whilst no stent occlusion occurred with covered SEMS. Conclusion: For malignant strictures, plastic stents had a significantly higher rate of occlusion and a lower duration of stent patency compared to SEMS. For benign biliary disease, all occluded stents were due to stents inadvertently left in situ for longer than recommended. A stent registry database is recommended to record all patients with biliary stents to ensure prophylactic stent exchange occurs at a timely interval to reduce the risk of biliary sepsis related to stent occlusion. For malignant strictures, earlier stent revision (! 2 months) should be considered if a plastic stent was inserted.