STENT-ASSOCIATED CHOLANGITIS FOLLOWING ENDOSCOPIC BILIARY STENT PLACEMENT - PREDICTIVE FACTORS AND OUTCOMES

Aims Cholangitis is a rare complication in patients with biliary stents and is associated with a mortality rate of 5-10%. The present study aims to evaluate predictive factors of cholangitis after biliary stent placement

Methods Retrospective cohort study, consecutively included all patients undergoing ERCP with biliary stent placement between 2015 and 2018. Stent associated cholangitis (SAC) was defined as need for further intervention (ERCP, CPT or surgery) or by clinical criteria of acute cholangitis in patients with biliary stents. The following parameters were evaluated: indication (stenosis, malignant obstruction, choledocholithiasis, acute cholangitis, biliary leak), previous cholecystectomy, previous sphincterotomy, presence and location of strictures, size and caliber of the prosthesis, serum bilirubin variation and time to SAC.

Results 110 patients were included, with a mean age of 72±15 years, most female (51%; n=56). The most frequent indications were choledocholithiasis in 44.5% (n=49) and acute cholangitis 31.8% (n=35). The majority were patients without prior sphincterotomy (80%; n=88) and no cholecystectomy (64.5%; n = 71). In most cases plastic (91.8%, n = 101) pigtail (62.7%, n = 69) stents were placed. The median caliber was 7Fr (AIQ-3) and the length 4cm (AIQ-2). The median total bilirubin at the time of ERCP was 2.4mg/dL (AIQ-4,8mg/dL). In 62.7% (n=69) bilirubin normalization occurred after stent placement.

SAC occurred in 20% (n=22), with a median of 24.5 days (AIQ-82) after stent placement. In 45.5% (n=10) there was no need for reintervention and in 40.9% (n= 9) ERCP was repeated. There was a significant association between SAC and presence of anatomic biliary stricture (p < 0.001) and choledocholithiasis (p = 0.040).

Conclusions Patients at increased risk of SAC include those with an anatomic stricture, and choledocholithiasis. Future protocols may reduce the risk of cholangitis in these patients.