Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Scand J Gastroenterol. 2023 Jul;58(7):798-804. doi: 10.1080/00365521.2022.2164210. Epub 2023 Jan 9.
The SARS-CoV-2 pandemic conditioned the optimal timing of some endoscopic procedures. ESGE guidelines recommend replacement or removal of the plastic biliary stents within 3-6 months to reduce the risk of complications. Our aim was to analyse the outcomes of patients who had delayed plastic biliary stent removal following endoscopic retrograde cholangiopancreatography (ERCP) in the pandemic era.
Retrospective study including consecutive ERCPs with plastic biliary stent placement between January 2019 and December 2021. Delayed removal was defined as presence of biliary stent >6 months after ERCP. The evaluated outcomes were stent migration, stent dysfunction, obstructive jaundice, cholangitis, acute pancreatitis, hospitalization, and biliary pathology-related mortality.
One-hundred and twenty ERCPs were included, 56.7% male patients, with a mean age of 69.4 ± 15.7 years. Indications for plastic biliary stent insertion were choledocholithiasis (72.5%), benign biliary stricture (20.0%), and post-cholecystectomy fistula (7.5%). Delayed stent removal occurred in 32.5% of the cases. The median time to stent removal was 3.5 ± 1.3 months for early removal and 8.6 ± 3.1 months for delayed removal. Patients who had delayed stent removal did not have a significantly higher frequency of stent migration (20.5 vs 11.1%, = 0.17), stent dysfunction (17.9 vs 13.6%, = 0.53), hospitalization (17.9 vs 14.8%, = 0.66), obstructive jaundice (2.6 vs 0.0%, = 0.33), cholangitis (10.3 vs 13.6%, = 0.77), acute pancreatitis (0.0 vs 1.2%, = 1.0), or biliary pathology-related mortality (2.6 vs 1.2%, = 0.55).
Delayed plastic biliary stent removal does not seem to have a negative impact on patients' outcomes. In the current pandemic situation, while scheduled endoscopic procedures may have to be postponed, elective removal of plastic biliary stents can be safely deferred.
SARS-CoV-2 大流行改变了一些内镜手术的最佳时机。ESGE 指南建议在 3-6 个月内更换或取出塑料胆管支架，以降低并发症风险。我们的目的是分析大流行时代内镜逆行胰胆管造影（ERCP）后延迟取出塑料胆管支架的患者的结局。
回顾性研究纳入 2019 年 1 月至 2021 年 12 月连续进行的 ERCP 并放置塑料胆管支架的患者。延迟取出定义为 ERCP 后胆管支架存在超过 6 个月。评估的结果是支架迁移、支架功能障碍、梗阻性黄疸、胆管炎、急性胰腺炎、住院和胆道疾病相关死亡率。
共纳入 120 例 ERCP，56.7%为男性患者，平均年龄为 69.4±15.7 岁。放置塑料胆管支架的指征为胆总管结石（72.5%）、良性胆管狭窄（20.0%）和胆囊切除术后瘘（7.5%）。32.5%的病例发生延迟支架取出。早期取出的中位支架取出时间为 3.5±1.3 个月，延迟取出的中位支架取出时间为 8.6±3.1 个月。延迟支架取出的患者支架迁移的频率（20.5%比 11.1%， = 0.17）、支架功能障碍（17.9%比 13.6%， = 0.53）、住院（17.9%比 14.8%， = 0.66）、梗阻性黄疸（2.6%比 0.0%， = 0.33）、胆管炎（10.3%比 13.6%， = 0.77）、急性胰腺炎（0.0%比 1.2%， = 1.0）或胆道疾病相关死亡率（2.6%比 1.2%， = 0.55）无显著差异。
延迟取出塑料胆管支架似乎不会对患者的结局产生负面影响。在当前大流行形势下，虽然计划的内镜手术可能不得不推迟，但可以安全地推迟择期取出塑料胆管支架。
