Department of Gastroenterology, Seth G S Medical College and K E M Hospital, 9Th Floor, Ward 32 A, Multistory Building, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Indian J Gastroenterol. 2024 Jun;43(3):592-600. doi: 10.1007/s12664-023-01469-y. Epub 2023 Nov 28.
BACKGROUND/AIMS: Proximal biliary plastic stent migration (PSM) remains a challenging complication. The study aims at determining the PSM rate, retrieval outcomes and factors associated with PSM.
Endoscopy database was analyzed from January 2016 to January 2021 to identify 1137 patients, who underwent stent removal or repeat endoscopic retrograde cholangiopancreatography (ERCP). Demography, methods of stent retrieval, outcomes and complications were noted. Logistic regression was performed to determine risk factors for PSM. Propensity score matching was done in a 1:1 manner using age, sex, comorbidities and indication to assess endoscopy-related factors. Clinical trial registration done (CTRI/2022/02/040516).
PSM was noted in 74 (6.5%) cases. Stent retrieval was successful in 94.59% (70/74) of cases. A balloon catheter (46/74) was commonly used. Technical failure was due to an impacted stent (2) and stent above the stricture (2). Complications were seen in 2.7% of cases. On multi-variate regression, sphincteroplasty at index ERCP (Odds ratio [OR] = 5.68, 95% confidence interval [CI] = 2.7-11.89), stent length < 10 cm (OR = 8.53, 95% CI = 3.2-22.47), 7-Fr stent (OR = 18.25, 95% CI = 6.5-50.64), dilated bile duct (mean diameter- 9.2 ± 3.94 mm) (OR = 0.384, 95% CI = 0.18-0.72) and delayed ERCP by > 3 months from index ERCP (OR = 15.28, 95% CI = 8.1-28.49). After performing propensity score matching for age, sex, comorbidities and indication to determine endoscopy-related factors, 7-Fr stent size (OR 3.495; 95% CI-1.23-9.93) and duration of indwelling stent for more than three months (OR-3.37; 95% CI-1.646-6.76) were significantly associated with proximal stent migration.
Proximally migrated straight stents can be successfully retrieved using standard accessories. The use of 7-Fr size stent, stents indwelling for more than three months, sphincteroplasty at index ERCP, stent length < 10 cm and dilated bile duct were associated with increased risk of proximal migration of straight biliary plastic stents. After propensity score matching, the use of 7-Fr size stents and stent indwelling for over three months were endoscopy-related factors associated with proximal migration.
背景/目的：近端胆道塑料支架迁移（PSM）仍然是一个具有挑战性的并发症。本研究旨在确定 PSM 发生率、取出结果和与 PSM 相关的因素。
从 2016 年 1 月至 2021 年 1 月，对内镜数据库进行了分析，共纳入 1137 例接受支架取出或重复内镜逆行胰胆管造影（ERCP）的患者。记录患者的人口统计学资料、支架取出方法、结果和并发症。采用逻辑回归确定 PSM 的危险因素。采用年龄、性别、合并症和适应证进行 1:1 倾向评分匹配，以评估内镜相关因素。临床试验已注册（CTRI/2022/02/040516）。
74 例（6.5%）发生 PSM。94.59%（70/74）的支架取出成功。通常使用球囊导管（46/74）。技术失败的原因是支架堵塞（2 例）和支架位于狭窄上方（2 例）。并发症发生率为 2.7%。多变量回归分析显示，索引 ERCP 时行括约肌切开术（比值比[OR] = 5.68，95%置信区间[CI] = 2.7-11.89）、支架长度<10cm（OR = 8.53，95%CI = 3.2-22.47）、7Fr 支架（OR = 18.25，95%CI = 6.5-50.64）、扩张胆管（平均直径-9.2 ± 3.94mm）（OR = 0.384，95%CI = 0.18-0.72）和索引 ERCP 后>3 个月延迟行 ERCP（OR = 15.28，95%CI = 8.1-28.49）。对年龄、性别、合并症和适应证进行倾向评分匹配以确定内镜相关因素后，7Fr 支架大小（OR 3.495；95%CI-1.23-9.93）和支架留置时间超过三个月（OR-3.37；95%CI-1.646-6.76）与近端支架迁移显著相关。
可使用标准器械成功取出近端迁移的直形支架。7Fr 支架大小、支架留置时间超过三个月、索引 ERCP 时行括约肌切开术、支架长度<10cm 和扩张胆管与直形胆道塑料支架近端迁移风险增加相关。在进行倾向评分匹配后，7Fr 支架的使用和支架留置时间超过三个月是与近端迁移相关的内镜相关因素。
