Introduction Endoscopic Retrograde Cholangiopancreatograpy (ERCP) and stent insertion is a mainstay of treatment for malignant distal biliary obstruction. Choice of stent remains controversial with plastic, uncovered and more recently introduced fully-covered self-expanding metal stents (SEMS) in use. Our aim was to examine the outcome of ERCP stent insertion using different stent types, in a large acute hospital.
Method We performed retrospective review of all cases of ERCP stent insertion in our unit for malignant distal biliary obstruction over a 5 year period to September 2013. Outcome data were collected for each case at 3, 6 and 12 months following stent insertion and statistical analysis performed using Fisher’s exact test.
Results 301 stents were placed for confirmed malignant obstruction in 237 patients; median age 73 years (range 35–98). Cumulative stent occlusion rates were significantly higher with plastic stents versus fully-covered SEMS at 3 months (15% vs 4%, p = 0.006), 6 months (30% vs 8%, p = 0.001) and 12 months (37% vs 12%, p = 0.001). Ascending cholangitis was significantly more frequent following plastic stent insertion than fully-covered SEMS at 6 months (20% vs 9%, p = 0.027) and 12 months (23% vs 12%, p = 0.017). There were no significant differences in rates of stent migration or cholecystitis between the stent types (Table 1), or in survival at 12 months. Compared with covered SEMS, unplanned repeat ERCP was significantly more likely following insertion of a plastic stent (32% vs 6%, p < 0.0001; NNH=3.9) or uncovered SEMS (20% vs 6%, p = 0.027; NNH 7.0).
Conclusion In this case series plastic stents were associated with significantly greater rates of stent occlusion and ascending cholangitis than fully-covered SEMS. There were no significant differences in rates of stent migration or gallbladder complications. Overall need for repeat unplanned ERCP was markedly reduced by fully-covered SEMS placement.
Disclosure of interest None Declared.
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