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Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis and Stent Dysfunction after Preoperative Biliary Drainage in Patients with Malignant Biliary Stricture
- Source :
- Internal medicine (Tokyo, Japan). 55(18)
- Publication Year :
- 2016
-
Abstract
- Objective To retrospectively evaluate the risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and stent dysfunction after performing preoperative biliary drainage (BD) in patients with malignant biliary stricture. Methods Between January 2003 and February 2013, 105 consecutive patients who had undergone transpapillary BD before surgery were enrolled in this study. Procedure-related complications, stent dysfunction rates, and their respective risk factors were investigated. PEP was defined according to the consensus guidelines. Results Fifty-five patients had bile duct cancer, 31 had pancreatic cancer, 16 had ampullary cancer, and 3 had gallbladder cancer. Endoscopic biliary stenting (EBS) and nasobiliary drainage (NBD) were performed in 84 patients and 21 patients, respectively. PEP occurred in 10% of the patients, with a significantly higher frequency in those with hilar/upper bile duct stricture (p=0.026) and a normal bilirubin level at admission (p=0.016). Of the 84 patients who underwent initial EBS, stent dysfunction occurred in 13%. The mean number of days from EBS to stent dysfunction was 14±12 days. A multivariate analysis revealed a male gender (p=0.048), a stent diameter ≤8 Fr (p=0.036), and an ERCP procedure time ≥45 minutes (p=0.021) to be risk factors for stent dysfunction. No NBD tube dysfunction was observed. Conclusion Patients with upper/hilar bile duct stricture or a normal bilirubin level are at high risk of developing PEP after preoperative BD. NBD or EBS with a large-bore stent is therefore recommended as preoperative BD.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Operative Time
Bile Duct Diseases
Constriction, Pathologic
Biliary Stenting
Gastroenterology
Bile duct cancer
03 medical and health sciences
0302 clinical medicine
Sex Factors
Risk Factors
Internal medicine
Pancreatic cancer
Internal Medicine
Medicine
Humans
Gallbladder cancer
Aged
Retrospective Studies
Cholangiopancreatography, Endoscopic Retrograde
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
business.industry
Bile duct
Stent
General Medicine
medicine.disease
Pancreatic Neoplasms
surgical procedures, operative
medicine.anatomical_structure
Treatment Outcome
Pancreatitis
030220 oncology & carcinogenesis
Drainage
030211 gastroenterology & hepatology
Female
Gallbladder Neoplasms
Stents
business
Subjects
Details
- ISSN :
- 13497235
- Volume :
- 55
- Issue :
- 18
- Database :
- OpenAIRE
- Journal :
- Internal medicine (Tokyo, Japan)
- Accession number :
- edsair.doi.dedup.....c49a6acf907e456d2fabd24904ea3b1e