Su1556 FEASIBILITY AND SAFETY STUDY OF A TEMPORARY BILIARY STENT FOR PROPHYLAXIS OF POST-ERCP CHOLANGITIS AFTER STONE REMOVAL

Abstract

Endoscopic treatment of common bile duct stone is usually performed through the major papilla. Despite sphincteroplasty through EST or endoscopic papillary large balloon dilatation (EPLBD), edema of papilla is common after treatment, that may induce cholangitis with cholestasis (post-ERCP cholangitis: PEC). Although few cases of post-ERCP cholangitis progress to severe cholangitis, it can cause prolongation of hospital stay. To avoid this complication, biliary decompression is sometimes necessary in addition to stone removal. In such a case, ENBD or biliary stent are employed, that causes discomfort to the patient, or that requires another endoscopic session to remove the inserted stent. This retrospective study evaluates prophylactic effect of a temporary biliary stent to prevent PEC which dislodges after commencement of oral intake. Between April 2011 and May 2017, endoscopic treatment of common bile duct stones was performed on 2055 naive cases in our hospital. Among them, temporary biliary stents were employed in 190 patients in the first session. To select the patients to compare the feasibility and safety of a temporary stent between stent group and non-stent group in a reduced bias condition, propensity score matching was introduced. As a temporary biliary stent, we used 5Fr.-5cm Geenen type stent (COOK), which has a flap on only one side. After complete stone removal which was checked by balloon occlusion cholangiogram, the deployment of a temporary was decided within operator’s discretion. The PEC was defined as oral intake delay which was decided by fever and abdominal pain with abnormal liver function test. The severity of PEC was classified according to Cotton’s criteria. The dislodgement of deployed stent was confirmed by an abdominal X-ray after oral intake. Other adverse events including post-ERCP pancreatitis were also evaluated. A total of 72 pairs of patients were selected by propensity score matching. The incident rate of PEC in stent group was significantly lower than non-stent group (1.4% vs 11.1%, p=0.033). In all cases, severity of PEC was mild or moderate. The length of hospital stay in stent group were significantly shorter than in non-stent group (6.5 days vs 8.3 days, p=0.038). The rate of PEP was 7% in stent group and 5% in non-stent group (NS; p=0.83). In 3 cases (4%) of stent group, stent retention in CBD was observed, which was successfully removed endoscopically. No other severe adverse event such as perforation of retained stent was observed. Temporary biliary stents are suggested to have preventive effects of post-ERCP cholangitis and shorten hospitalization.