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Complications and management of forgotten long-term biliary stents

World Journal of Gastroenterology 2017年第4期23卷 622-628页

作者： Se Hoon Sohn Jae Hyun Park Kook Hyun Kim Tae Nyeun Kim Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea

AIM To evaluate complications and management outcomes of retained long-term plastic biliary stents.METHODS Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of longterm plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher's exact test and χ~2 tests. Statistical significance was defined as P stent insertion were bile duct stones(63.2%, 24/38) and benign bile duct stricture(52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases(26.3%), stents were retained for more than 24 mo. Common bile duct(CBD) stones or sludgewere found in most cases(92.1%, 35/38). The most common complication was acute cholangitis(94.7%, 36/38). stent removal by endoscopic approach was successfully performed in 92.1%(35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7%(28/38) of the cases. When patients were divided into two groups by duration of stent placement(12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents. CONCLUSION The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.

关键词：胆汁的 stent 长期的复杂并发症忘记的 stents 尖锐胆管炎胆汁的石头

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Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

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World Journal of Gastroenterology 2017年第4期23卷 735-739页

作者： Muneji Yasuda Hideki Sato Yuki Koyama Tomoki Sakakida Takumi Kawakami Takeshi Nishimura Hideki Fujii Yoshikazu Nakatsugawa Shinya Yamada Naoya Tomatsuri Yusuke Okuyama Hiroyuki Kimura Takaaki Ito Hiroyuki Morishita Norimasa Yoshida Department of Gastroenterology and Hepatology Japanese Red Cross Kyoto Daiichi Hospital Department of Radiology Japanese Red Cross Kyoto Daiichi Hospital

Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.

关键词：胆汁的 stent 塑料 stent 胆汁的流血 Pseudoaneurysm 辫子 stent

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Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

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World Journal of Gastrointestinal Endoscopy 2017年第1期9卷 12-18页

作者： Hiroshi Ohyama Rintaro Mikata Takeshi Ishihara Yuji Sakai Harutoshi Sugiyama Shin Yasui Toshio Tsuyuguchi Department of Gastroenterology and Nephrology Graduate School of MedicineChiba UniversityChiba 260-8677Japan

AIM To investigate endoscopic therapy efficacy for refractory benign biliary strictures(BBS) with multiple biliary stenting and clarify predictors.METHODS Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents(7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. stents were removed approximately 1 year after initial stenting. BBS and common bile duct(CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared.RESULTS Endoscopic therapy was completed in 8(80%) patients, whereas 2(20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two(20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six(60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group(6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation(complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo.CONCLUSION Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.

关键词：长期的胰腺炎胆汁的苛评胆汁的 stent 胰腺的石头内视镜检查法

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