Real-life patency of plastic biliary stents in the pandemic era: is stent removal after 6 months safe and effective?

Abstract

Background

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.

Methods

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.

Results

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%, p = 0.17), stent dysfunction (17.9 vs 13.6%, p = 0.53), hospitalization (17.9 vs 14.8%, p = 0.66), obstructive jaundice (2.6 vs 0.0%, p = 0.33), cholangitis (10.3 vs 13.6%, p = 0.77), acute pancreatitis (0.0 vs 1.2%, p = 1.0), or biliary pathology-related mortality (2.6 vs 1.2%, p = 0.55).

Conclusions

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.

Keywords:

• Endoscopic retrograde cholangiopancreatography
• ERCP
• plastic biliary stent
• delayed removal
• complications
• pandemic
• SARS-CoV-2

Author contributions

Freitas M. designed the study, acquisition and analysis of data, did the literature research and drafted the manuscript. Cúrdia Gonçalves T., Boal Carvalho P., and Rosa B. performed the ERCP procedures, designed the study and revised the manuscript. Lima Capela T., and Macedo Silva V. participated on the acquisition of data and performed the statistical analysis. Marinho C. revised the manuscript. Cotter J. critically revised the manuscript and approved the final version to be submitted.

Disclosure statement

No potential conflict of interest was reported by the authors.