World journal of gastrointestinal surgery · 2025
Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study.
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Zhang Hong-Lei, Zhang Cheng, Qiu Chen, Zhang Bo-Sen, Huang An-Hua, Yang Jian-She, Jiang Zhao-Yan, Zheng Liang, Hu Hai, Yang Yu-Long
Аннотация
BACKGROUND: 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.
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.