Duration and predictive factors of plastic biliary stent patency: results of large prospective database analysis

Aims Endoscopic biliary stenting is the main minimally invasive treatment option for duct obstruction. Occlusion of the stent is the most common and severe complication. The mechanism of the biofilm formation on a plastic stent resulting in occlusion is well known, however, factors affecting the rate of biofilm formation and individual stent patency are still unclear. The aim of this study was to determine the duration and factors affecting plastic biliary stent patency.

Methods A retrospective analysis of the prospectively maintained database of the consecutive procedures of endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent placement with the intention of stent being present for more than a month in a single tertiary care center during the period of 2010 and 2019. Demographic (age, gender) and clinical data (aetiology of the biliary obstruction, presence of cholangitis, use of antibiotics, presence of the common bile duct and gallbladder stones, history of cholecystectomy, number and diameter of stents being placed, time to the next ERCPs and whether the subsequent stent placement was performed as an emergency) from hospital records.

Results 2319 consecutive ERCPs and plastic biliary stent placement were included. Average age of the stented patient was 63,3±15,2 years, with 54,7% of the cohort being male. 38,9% of the patients were diagnosed with cholangitis and 57,6% received antibiotics. 38,9% (N=902) of the stent placements were for extraductal malignancy, 19,5[TP1]% (N=453) for cholangiocarcinoma, 31,6% (N=734) for benign obstruction and 9,9% (N=230) for parasitic infestation. The average cumulative diameter of the placed stents was 12,9±4,5Fr. The median stent patency was 64 [IQR 26–97] days. 28,2% (N=655) of the patients consequently developed cholangitis and 32,9% (N=763) underwent emergency re-stenting. Etiology of the obstruction and subsequent stenting being perfromed as emergency correlated significantly, p<0,001. There was a notable difference in stent patency time[TP2] when comparing patients according different aetiology of biliary stricture (log-rank test p<0,001). Multivariate logistic regression analysis revealed that male sex (OR 0,78, 95% CI 0,63-0,98, p=0,04) and presence of CBD stones (OR 0,64, 95% CI 0,48-0,85, p=0,002) had a protective effect from the subsequent ERC being performed as an emergency, whereas cholangitis on the initial procedure increased this likelihood (OR 2,6, 95% CI 1,9-3,4, p<0,001).

Conclusions Our study shoes that aetiology of the biliary obstruction plays a major role in the duration of the plastic stent patency. These findings warrant further prospective studies in bile biochemistry and microbiome to identify particular factors affecting stent patency in the hopes of personalizing care practice and potentially prolonging stent patency.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025