Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2018; 10(1): 45-50
Published online Jan 16, 2018. doi: 10.4253/wjge.v10.i1.45
Management of endoscopic biliary stenting for choledocholithiasis: Evaluation of stent-exchange intervals
Gen Tohda, Masaki Dochin
Gen Tohda, Masaki Dochin, Department of Gastroenterology, Fukui Kosei Hospital, Fukui 918-8537, Japan
Author contributions: Tohda G wrote the manuscript and analyzed the data; Dochin M reviewed the manuscript.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki, and was reviewed ethically and approved by the Fukui Kosei Hospital Institutional Review Board.
Informed consent statement: All patients involved in this study gave their written informed consent about disclosure of their protected medical information.
Conflict-of-interest statement: Authors declare no conflict of interest relevant to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gen Tohda, MD, PhD, Chief Doctor, Department of Gastroenterology, Fukui Kosei Hospital, Shimo-rokujyo 201, Fukui 918-8537, Japan. gtoda@koseikaigroup.jp
Telephone: +81-776-413377 Fax: +81-776-413372
Received: October 15, 2017
Peer-review started: October 24, 2017
First decision: November 23, 2017
Revised: November 30, 2017
Accepted: December 6, 2017
Article in press: December 7, 2017
Published online: January 16, 2018
ARTICLE HIGHLIGHTS
Research background

In elderly patients with serious comorbidities, endoscopic biliary stenting is widely used as a safe approach for the management of choledocholithiasis. Although short intervals for plastic stent exchange have commonly been recommended to avoid acute cholangitis, it is difficult for elderly patients with numerous comorbidities to accept biliary stent exchange in such a short period. We evaluated the safe interval of endoscopic biliary stent exchange for choledocholithiasis.

Research motivation

There has been limited data on the outcome of long-term biliary stenting for choledocholithiasis. In order to reduce the unnecessary medical procedures for high-risk patients, the optimal time for biliary stent exchange has to be established.

Research objectives

The principal aim of this study is an evaluation of the adequate intervals for biliary stent exchange as a treatment for patients with choledocholithiasis. This research will contribute to the management of endoscopic biliary stenting for choledocholithiasis of high-risk patients.

Research methods

Patients with symptomatic choledocholithiasis were treated with biliary plastic stents because complete endoscopic stone retrieval was difficult. Stent exchange was carried out at every 6 mo or every 12 mo. In the patients who didn’t accept the recommendation of regular stent exchange, biliary stents were replaced when clinical symptoms appeared. The authors evaluated the frequency of biliary complication and stent patency rate during follow-up periods.

Research results

Regarding the stent patency rate, there is no significant difference between the 6 mo stent exchange group and the 12 mo stent exchange group. Although a high incidence of acute cholangitis occurred in the on demand stent exchange group, there was no biliary-related mortality.

Research conclusion

Although exchanges of plastic stent in short intervals have been recommended to avoid acute cholangitis, this study concluded that 12 mo is considered a safe interval for plastic stent exchange in choledocholithiasis. Long-term biliary stenting longer than 12 mo can also be an acceptable option for selected patients who are medically unfit for further invasive procedures, but we have to observe these cases carefully because of the high frequency of acute cholangitis.

Research perspectives

The authors’ research findings contribute to the discussion about safe interval for plastic stent exchange in choledocholithiasis. The study design is retrospective and sample size is small, so further clinical trials in a large population under prospective design will be valuable.