Stenting as a definitive procedure in benign biliary disease

To assess the efficacy of biliary stent insertion for benign disease.

A five year review of all patients who underwent endoscopic retrograde cholangio-pancreatography (ERCP). Those who had a stent inserted for benign biliary disease were retrospectively analysed by chart review, family doctor contact and death certificate checking.

A large district general hospital providing an ERCP service for 200,000 people.

Thirty-one patients (mean age 75) were identified who had biliary endoprostheses inserted for unextractable stones (20) solitary stricture (3) or both (8).

Complications requiring stent change and stent-related death were the clinical measurements recorded. Serum bilirubin and alkaline phosphatase were also measured.

Ten (32%) patients died a mean of 12 months after the procedure. One stricture patient died from causes related to the biliary tract. The remaining 21 patients were followed for a mean of 29 months and all are asymptomatic. Complications developed in 6 patients a stricture being present at initial stenting in 5 of these six patients. Requirement for further procedures was statistically more frequent in patients with stricturing (45% v 5% p < 0.05). Although initially, no different alkaline phosphatase levels on latest follow-up were significantly higher in patients who had a stricture at initial ERCP (512 v 176 p < 0.005).

Stenting for unextractable biliary stones in patients judged unfit for surgery is a safe and effective procedure. Stenting in the presence of biliary strictures carries a significantly greater risk of future complications.