Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is an established technique for palliative stenting and symptomatic relief of obstruction of the biliary tree. Although mortality following ERCP is high in patients with advanced age and a malignant diagnosis, a Cochrane review has shown that endoscopic stents have reduced complications and mortality compared with surgical bypass in inoperable pancreatic cancer. Furthermore metal stents have improved patency in biliary obstruction than plastic stents. Our aim was to evaluate patient outcomes following endoscopic metallic stenting at a specialist tertiary referral centre, including the need for re-intervention and mortality rates.
Methods We performed a retrospective audit and service evaluation for all endoscopic metallic biliary stent procedures at Queen's Medical Centre, Nottingham University Hospitals Trust over a 1-year period during 2010 with patients receiving at least 1-year follow-up. Demographic data, the need for repeat intervention (either endoscopic or radiological), procedure-related complications and mortality were determined.
Results During 2010, 40/776 (5.2%) patients undergoing ERCP had metallic biliary stents inserted; uncovered Zilver® stents (Wilson Cook, USA) n=38 (95%), covered Niti-S® stents (Taewoong Medical, S. Korea) n=2 (5%). Of these 22 (55%) were male and mean (±SD) age was 73.1±12.3 years. Final diagnosis was pancreatic cancer; n=22 (55%), cholangiocarcinomas; n=13 (33%), other malignancy; n=3 (7%) and benign stricture; n=2 (5%). Strictures were located either distally n=25 (63%), mid-duct strictures n=4 (10%) or proximal/hilar strictures n=11 (27%). All patients underwent radiological imaging prior to ERCP. 22 patients (55%) had undergone prior ERCP with the majority, 21/22 (95%) patients, having confirmed cytological diagnosis of malignancy and 20/22 (91%) patients having previous biliary stents in situ. These were predominantly plastic stents which had blocked or required stent exchange. All cause 1-year mortality was 80%, with median (range) survival 120 (6–361) days. 7-day and 30-day mortality was 5% and 13% respectively. There were no immediate reported complications at time of endoscopy. 9/40 (22.5%) patients required further ERCP or percutaneous transhepatic cholangiography stenting procedures. All re-interventions were in patients with uncovered stents; 6 due to tumour in growth or stent occlusion and one due to stent misplacement.
Conclusion Although technical success and immediate complications were satisfactory, need for re-intervention was required in 22.5%. Median survival and stent patency in this study is comparable to data from the Cochrane review, however further work is required to compare different metallic stent construction or other manoeuvres to reduce the need for re-intervention.
Competing interests None declared.
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