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cbd stent removal

Materials and methods: 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.

Conclusions: 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.

Objective: 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.

Results: 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).

60 years female patient admitted in surgery ward with features of cholangitis with computed tomography showing cholangitic abscess with dilated common bile duct and sludge around stent in situ. Stone was found at proximal end of stent during surgery.

Our patient, a 60 years old female, presented with pain in abdomen since 8 days with nonbillious vomiting and low grade fever. Past history was suggestive of obstructive jaundice in 2007. CT abdomen (2007) suggested benign stricture in lower CBD but no gallstones, brush cytology was negative for malignant cells. Patient underwent ERCP, sphincterotomy with CBD stenting on 2/8/2007. Patient was advised follow up for stent removal after one month. Patient did not go for stent removal as she had no complaints.

Discussion

Choledocholithiasis is presence of stone in Common bile duct (CBD) which can be treated by endoscopy or surgery [1]. Retained foreign bodies like stents forms a nidus for stone formation resulting in pain, fever, jaundice.

1. Introduction

Choledocholithiasis is evident in approximately 10–15% patients with gallstones, more commonly secondary. However primary common bile duct (CBD) stones are more common in Asia. Choledocholithiasis can be treated by endoscopy or surgery [1] . Recent trend is to do ERCP primarily and stone extraction with or without CBD stenting. If not removed within time (4–6 weeks), Stent can act as a nidus for stone formation [2] , [3] . Here we discuss a case of Choledocholithiasis in a forgotten biliary stent (∼8.5 years).