Endoscopic plastic stenting for bile duct stones: stent changing on demand or every 3 months. A prospective comparison study

Abstract

In patients with bile duct stones who were treated with biliary plastic stents, the best stent management to avoid cholangitis was stent changing at defined intervals (every 3 months in the current study). The data confirmed that plastic biliary stenting may decrease stone size with a high percentage of subsequent total stone clearance.

Updated guideline on the management of common bile duct stones (CBDS)

“…Over a mean follow-up period of 14 months, there was a 36% cholangitis rate in patients who had stents changed on demand with an associated mortality of 8%. Patients who had stents changed electively at three monthly intervals had an 8% cholangitis rate and 2% mortality 141. As such, patients faced a high risk of complication or multiple interventions.…”

Endoscopic Retrograde Cholangiopancreatography for the Management of Common Bile Duct Stones and Gallstone Pancreatitis

“…[14][15][16][17] A recent randomized, prospective, multicenter study evaluated recommended versus on demand time intervals for exchanges of indwelling biliary stents to manage high-risk patients with choledocholithiasis. Seventy-eight elderly (mean age, 76 years) patients with large and/or multiple stones (18 mm; mean stone burden of 21 per patient) deemed not to be operative candidates were managed with stent placement without intraductal lithotripsy.…”

“…Stone clearance was ultimately successful in 58% of patients, without differences between the groups. 15 A substantial risk of cholangitis is inherent with this overall approach, with studies reporting incidence rates as high as 13% to 38% and endoprosthesis related mortality rates as high as 16%. 14,15,18,19 Lower rates of cholangitis may be associated with set intervals between stent exchanges, shorter duration of stent dwell time to subsequent attempts for clearance, and use of multiple stents.…”

“…15 A substantial risk of cholangitis is inherent with this overall approach, with studies reporting incidence rates as high as 13% to 38% and endoprosthesis related mortality rates as high as 16%. 14,15,18,19 Lower rates of cholangitis may be associated with set intervals between stent exchanges, shorter duration of stent dwell time to subsequent attempts for clearance, and use of multiple stents. 13,15,16,20 An initial enthusiasm for the use of ursodeoxycholic acid as an adjunct to biliary endoprosthesis approach has been diminished after a recent randomized, multicenter, prospective study failed to demonstrate incremental benefit to reduction in stone size.…”

“…14,15,18,19 Lower rates of cholangitis may be associated with set intervals between stent exchanges, shorter duration of stent dwell time to subsequent attempts for clearance, and use of multiple stents. 13,15,16,20 An initial enthusiasm for the use of ursodeoxycholic acid as an adjunct to biliary endoprosthesis approach has been diminished after a recent randomized, multicenter, prospective study failed to demonstrate incremental benefit to reduction in stone size. 20 Finally, stents with degradable membranes, eluting EDTA and sodium cholate are being evaluated and have demonstrated some promise at the level of ex vivo and animal studies.…”