Risk Factors for Common Bile Duct Stent Occlusion after Endoscopic Retrograde Cholangiopancreatography

Abstract

Introduction: Endoscopic biliary stenting is a common procedure performed in gastrointestinal endoscopy to manage various bile duct disorders. The safety and efficacy of common bile duct (CBD) stenting for relieving CBD obstruction and management of other complications is well established. One of the common complications of CBD stent placement is stent occlusion. The risk factors which can predict stent occlusion are not well studied in literature. Aim of our study was to identify potential risk factors that are associated with stent occlusion in patients with CBD stents. Methods: This case control study included all patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with CBD stent placement at our institution from January 2009 to December 2014. The study group included all patients with CBD stents who were subsequently found to have an occluded stent. A control group was randomly selected in 1:1 ratio, and included all patients with CBD stent placement but without stent occlusion during the course of their management. Descriptive statistics were computed for all variables including means, medians, ranges for continuous variables. Data is presented as mean ± standard deviation, median [25th, 75th percentiles or interquartile range, IQR] or N (%). A univariate and multivariate analysis was performed to compare the groups; Results: A total of 394 patients were included in the analysis of which 197 were in the study group and 197 in the control group. Average age of the study cohort was 63.5 ± 14.8 years and 215 (54.8%) were males. The baseline and demographic data was similar in the two groups. On univariate analysis, patients with history of smoking were 1.52 times (1.14-2.04) more likely to have stent occlusion (p=0.04). Patients with cirrhosis were 1.91 times (1.42-2.57, p On multivariate analysis, history of smoking, pancreatic mass causing CBD obstruction, length of stricture and plastic stent placement were all associated with stent occlusion (Table 1).Table 1: Cox Proportional Hazards AnalysisConclusion: Patients with history of smoking, presence of pancreatic mass, and longer strictures are at higher risk for CBD stent occlusion after ERCP. Plastic stents are also at higher risk of stent occlusion compared to metal stents. Patients with these risk factors should have their follow-up ERCP scheduled appropriately early to prevent complications.