Endoscopic biliary drainage is effective in 90 percent of all attempted cases of biliary strictures and 80 percent of malignant biliary strictures. It carries lower morbidity compared to surgical and radiological approaches. Our aim is to review our practice of biliary self-expandable metal stents (SEMs) insertion in a high endoscopy volume district general hospital looking into stent related complications and benign biliary stricture remodelling.Methods
185 endoscopic retrograde cholangiopancreatography (ERCP) with biliary SEMs insertion were performed in 166 patients at the Royal Bournemouth Hospital between January 2010 and November 2016. We retrospectively reviewed the indications of biliary SEMs insertion, early and late stent related complications. Early complication is defined as adverse events and stent occlusion or migration within the first 7 days of stent deployment.Results
Out of 185 ERCPs, 153 were done in 142 patients with malignant strictures, 27 done in 19 patients with benign strictures and 5 done for 5 patients with indeterminate strictures. 122 uncovered SEMs(UCSEMs) were inserted in malignant strictures whereas 30, 22 and 4 fully covered SEMs(FCSEMs) inserted in malignant, benign and indeterminate strictures respectively. Early complications from SEMs insertion include biliary infection (3.24%), pancreatitis (1.08%), bleeding (1.08%), perforation (0.54%), and failure of initial ERCP requiring repeat procedure (1.08%) across all biliary strictures. Rate of stent dysfunction in UCSEMs, FCSEMs and combined plastic and FCSEMs were 17.1%, 37.5% and 33.3% respectively. 12 out of 17 patients had benign strictures remodelled, with mean time from index ERCP to remodelling being 50.5 months (range 21.1–137.8 months). Benign stricture remodelling rate were 100% (4/4) in stone disease, 100% (1/1) in post-cholecystectomy related stricture and 58.3% (7/12) in chronic pancreatitis.Conclusions
Our data appears comparable to larger studies. In our cohort there is a clear contrast in stent dysfunction between FCSEMs and UCSEMs. Biliary sepsis post SEMs insertion seems higher than the published European data and this probably reflects the change in practice in our hospital for advocating against antibiotic prophylaxis. Plastic stent within FCSEMs did not significantly reduce the risk of stent migration.