Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during sec...Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.展开更多
基金Supported by the Key Specialty Construction Project of Shanghai Pudong New Area Health Commission,No.PWZzk2022-17the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2021-06+1 种基金Clinical Research Project of Shanghai East Hospital,No.DFLC2022019Shanghai Dongfang Hospital Key Discipline Department of Gallstone Disease,No.2024-DFZD-005DS.
文摘Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.
