Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised

ObjectiveEndoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at pot...

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Bibliographic Details
Published in:Frontline gastroenterology 2024-03, Vol.15 (2), p.99-103
Main Authors: Ahmed, Jamal, Prakash, Priyanka, Mehta, Gney, Davies, Tessa, Lim, Yin Yin, Cross, Nicholas D, Czajkowski, Marek Alexander, Allison, Miles Clifford
Format: Article
Language:English
Subjects:
ABDOMINAL PAIN
BILE DUCT STONES
Bile ducts
BILIARY OBSTRUCTION
Cholangitis
Cholecystectomy
Death & dying
ENDOPROSTHESIS
ENDOSCOPIC BALLOON SPHINCTEROPLASTY
Endoscopy
Gallbladder
Hospitalization
Life expectancy
Liver
Pancreatobiliary
Patients
Phosphatase
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Summary:ObjectiveEndoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes.Design/methodOutcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023.ResultsThere were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula.ConclusionsLong-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures.
ISSN:2041-4137
2041-4145
DOI:10.1136/flgastro-2023-102461