Kim Shawn J, Ohanian Edmond, Lee Frances, Nam Bryan, Che Kendrick, Laine Loren, Kim Sarah E, Kim John J
a Division of Gastroenterology , Loma Linda University Medical Center , Loma Linda , CA , USA.
b Section of Digestive Diseases , Yale University School of Medicine , New Haven , CT , USA.
Scand J Gastroenterol. 2017 Oct;52(10):1128-1132. doi: 10.1080/00365521.2017.1342138. Epub 2017 Jun 28.
Plastic biliary stents are commonly placed during endoscopic retrograde cholangiopancreatography (ERCP) and should be removed or replaced within 3 months to reduce the risk of stent obstruction. The aim of the study was to identify predictors and outcomes of patients who had delayed plastic biliary stent removal following ERCP.
Consecutive patients who received ERCP with plastic biliary stent placement at Loma Linda University Medical Center (10/2004-6/2013) were identified. Delayed removal was defined as presence of stent >3 months after index ERCP. Multivariable regression analysis to identify baseline characteristics associated with delayed removal was performed. Clinical outcomes of stent obstruction (e.g., cholangitis, hospitalization, intensive care) were also collected for those with delayed removal.
Among 374 patients undergoing ERCP with plastic biliary stent, 71 (19%) had delayed stent removal. Patients who had anesthesia assistance (AOR = 3.8, 95%CI 1.2-11.4), non-English primary language (AOR = 3.0, 95%CI 1.5-6.2), and outpatient ERCP (AOR = 2.0, 95%CI 1.1-3.4) had increased while choledocholithiasis (AOR = 0.5, 95%CI 0.3-0.99) had lower odds of delayed stent removal. Among those with delayed removal, 13 (18%) were hospitalized for stent obstruction (5 (7%) had cholangitis, 8 (11%) were hospitalized for more than a week, and 3 (4%) required intensive care).
Almost one-fifth of patients who underwent ERCP with plastic biliary stent placement had delayed removal with nearly one-fifth of these patients requiring hospitalization for stent obstruction. Targeting patients at risk by improving communication and ease of scheduling an ERCP may reduce preventable adverse events associated with delayed biliary stent removal.
塑料胆管支架通常在内镜逆行胰胆管造影术（ERCP）期间放置，应在3个月内取出或更换，以降低支架阻塞的风险。本研究的目的是确定ERCP术后延迟取出塑料胆管支架的患者的预测因素和预后。
确定在洛马林达大学医学中心（2004年10月至2013年6月）接受ERCP并放置塑料胆管支架的连续患者。延迟取出定义为首次ERCP后支架留置时间超过3个月。进行多变量回归分析以确定与延迟取出相关的基线特征。还收集了延迟取出患者的支架阻塞临床结局（如胆管炎、住院、重症监护）。
在374例行ERCP并放置塑料胆管支架的患者中，71例（19%）延迟取出支架。接受麻醉辅助的患者（调整后比值比[AOR]=3.8，95%置信区间[CI]1.2 - 11.4）、以非英语为主要语言的患者（AOR = 3.0，95%CI 1.5 - 6.2）和门诊ERCP患者（AOR = 2.0，95%CI 对延迟取出支架的可能性增加，而胆总管结石患者（AOR = 0.5，95%CI 0.3至0.99）延迟取出支架的可能性较低。在延迟取出的患者中，13例（18%）因支架阻塞住院（5例（7%）发生胆管炎，8例（11%）住院超过一周，3例（4%）需要重症监护）。
近五分之一接受ERCP并放置塑料胆管支架的患者延迟取出支架，其中近五分之一的患者因支架阻塞需要住院治疗。通过改善沟通和简化ERCP的安排来针对高危患者，可能会减少与延迟胆管支架取出相关的可预防不良事件。
