Retained biliary plastic stents – lest we forget

Abstract

Prolonged indwelling of endoscopically placed biliary plastic stents may lead to complications. We conducted a retrospective analysis of patients who underwent endoscopic retrograde cholangio-pancreaticography (ERCP) at our centre in 2017 and were noted to have retained biliary plastic stents ( > 3 months after an index ERCP). A total of 127 patients had previously placed biliary plastic stents, out of which 45 (35.4%) were retained. The median age of the latter was 52 years (range = 22–79 years) with 27 (60%) patients being men. The median duration of the retained stents was 144 days (range = 94–3292 days). The majority of the patients were asymptomatic. However, 9 (20%) patients had cholangitis, 2 (4.4%) had choledocholithiasis, 2 (4.4%) had cholangitic abscess and 1 (2.2%) developed septicaemia. Fortunately, all these complications could be managed medically and endoscopically. Retention of biliary plastic stents is a problem often overlooked and underestimated in clinical practice. Various measures need to be instituted to create awareness of this entity to prevent undesirable outcomes.

Retained Biliary Plastic Stents: Clinical Presentation, Complications, and Management

“…8 The durations of CBD PS retention in various studies by Chandra and colleagues, Sohn et al, and Jaleel et al was 3.53 years (range 1-14 years), 22.6 AE 12.8 months, and 144 days (94-3,929 days), respectively. 4,5,9 In other studies, it was shown that CBD PS patency ranges from 2.7 to 7 months for benign diseases and from 1.8 to 5.7 months for malignant biliary diseases. [10][11][12][13][14] In our study, the median duration of stent retention was 5 months (IQR ¼ 4-6 months).…”

“…Similarly, in the study by Jaleel et al, all patients were managed medically and endoscopically (18/45 patients required further sessions) while Kumar et al reported definitive endoscopic treatment only in 5 patients (23.8%) and necessity of surgical exploration in remaining 16 (76.2%) cases. 4 9 Sohn et al reported successful endoscopic management of retained CBD stent in 35 of 38 patients (92.1%). 5 While most studies have reported > 90% success with endoscopic measure, Chandra and colleagues had lower success which can be attributed to selection and referral bias from a surgical center, lack of technical expertise, and access to various newer accessories and cholangioscopy.…”

“…Kumar et al and Sohn et al reported cholangitis as the most common presentation when stent retention was more than 12 months, while Jaleel et al found majority (68.9%) were asymptomatic when stents were retained > 3 months. 4,5,9 The reported incidence of cholangitis associated with plastic biliary stents ranges from 8 to 40% of patients. [15][16][17] Reported mortality in patients with stent-related cholangitis is as high as 6.7% in long-term biliary stenting for choledocholithiasis.…”

“…Jaleel et al assessed 45 patients with retained biliary stents longer than 3 months and noticed that majority were asymptomatic with acute cholangitis in 9, choledocholithiasis in 2, and cholangitic abscess in 1 case. 4 Sohn et al evaluated 38 patients with biliary stent left for more than 12 months and found acute cholangitis in 36 (94.7%) cases and stones and sludge in 35 (92.1%) cases. 5 In a case series of 48 patients with plastic biliary stents retained for > 12 months, by Duman et al, the most frequent complications were stone formation (79%) and proximal stent migration (26.4%).…”

A rare case of massive hepatic abscess 6 years after ERCP due to retained biliary stent

“…Retained biliary stents for a prolonged period without follow up may cause serious, or even life-threatening, complications such as acute cholangitis, pancreatitis, internal stent migration, endoprosthesis occlusion and obstructive jaundice (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In these cases, the mortality rate can reach up to 12% (3).…”