Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland.
Dig Endosc. 2013 Jul;25(4):440-3. doi: 10.1111/j.1443-1661.2012.01399.x. Epub 2012 Dec 5.
Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice for the management of choledocholithiasis. Biliary stenting facilitates repeated attempts at stone extraction. The aim of the present paper was to assess long-term outcomes of patients where biliary stenting was used as the primary treatment for the management of choledocholithiasis.
We undertook a review of a prospectively maintained database of all ERCP carried out at a single institution. All patients had stones not amenable to endoscopic retrieval.
Between January 1998 and December 2008, 3655 ERCP were carried out in our unit. Of these, 201 (120 female) patients met our inclusion criteria. All patients underwent ERCP and sphincterotomy, followed by insertion of a double pigtail 7-Fr plastic stent. Repeat ERCP was not scheduled routinely. Stent change was only carried out in patients when clinical suspicion of stent blockage occurred. Median stent patency was 59.6 months (interquartile range 47.7-71.2). At 6 months, stent patency was 93.5%, and at 24 months, it was 81.9%. Serious adverse outcomes with blocked stents were uncommon, and tended to occur early. Cholangitis was seen in only 7.4% (6) of patients (median stent patency 11.8 months) and jaundice was seen in 18.5% (15 patients, median stent patency 7.2 months).
Our data demonstrate median stent patency of almost 5 years. The low incidence of significant complications with blocked stents and excellent stent patency rates suggest that long-term biliary stenting is an acceptable alternative in elderly, frail patients with stones that are not endoscopically retrievable.
经内镜逆行胰胆管造影术（ERCP）是治疗胆总管结石的首选方法。胆道支架置入术有助于多次尝试取石。本研究旨在评估胆道支架置入术作为胆总管结石的主要治疗方法的患者的长期疗效。
我们对一家机构进行的所有 ERCP 进行了前瞻性数据库回顾。所有患者的结石均不适宜进行内镜取石。
1998 年 1 月至 2008 年 12 月，我院共进行了 3655 例 ERCP。其中 201 例（120 例女性）患者符合我们的纳入标准。所有患者均接受 ERCP 和括约肌切开术，随后置入双猪尾 7Fr 塑料支架。常规不安排重复 ERCP。仅当临床怀疑支架堵塞时才进行支架更换。中位支架通畅时间为 59.6 个月（四分位间距 47.7-71.2）。6 个月时支架通畅率为 93.5%，24 个月时为 81.9%。支架堵塞的严重不良事件并不常见，且往往发生较早。胆管炎仅见于 7.4%（6 例）患者（中位支架通畅时间 11.8 个月），黄疸见于 18.5%（15 例，中位支架通畅时间 7.2 个月）。
我们的数据显示中位支架通畅时间接近 5 年。支架堵塞的并发症发生率低，且支架通畅率高，这表明对于无法内镜取石的老年、体弱结石患者，长期胆道支架置入术是一种可接受的替代方法。
