DEN open · 2025
Scheduled Inside Plastic Stent Exchange Prevents Cholangitis and Reduces Unplanned Hospitalization in Patients With Unresectable Malignant Hilar Biliary Obstruction.
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Muramatsu Joji, Ishikawa Kazuma, Suzuki Norito, Kubo Tomohiro, Yoshida Makoto, Omori Ginji, Ito Ryo, Miura Shogo, Takada Kohichi
Аннотация
OBJECTIVES: To prevent cholangitis in patients with unresectable malignant hilar biliary obstruction (MHBO), we recently implemented scheduled inside plastic stent (IS) exchange every 2-4 months. This study aimed to evaluate whether this strategy prevents cholangitis onset and reduces unplanned hospitalizations without increasing adverse events.
METHODS: This retrospective single-center study included patients with unresectable MHBO who underwent IS placement between 2011 and 2023. Patients were divided into two groups: those who underwent scheduled IS exchange (scheduled group, n = 12) and those who received on-demand IS exchange (on-demand group, n = 29). We compared unplanned hospitalization duration and number, time from initial IS placement to cholangitis onset, 1-year cholangitis-free rate from initial IS placement, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, and prognosis.
RESULTS: Median duration of unplanned hospitalizations was significantly shorter in the scheduled group compared to the on-demand group (0 days [range: 0-83] vs. 38.5 days [0-140], p = 0.03). The time from initial IS placement to the onset of cholangitis was also significantly longer in the scheduled group (median 203 days [range: 54-463] vs. 89 days [4-1081], p = 0.02). The 1-year cholangitis-free rate was significantly higher in the scheduled group (50% vs. 10%, p = 0.01). No significant differences were found in the number of unplanned hospitalizations, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, or prognosis.
CONCLUSIONS: Scheduled IS exchange delays the onset of cholangitis and reduces the duration of unplanned hospitalizations without increasing adverse events.
METHODS: This retrospective single-center study included patients with unresectable MHBO who underwent IS placement between 2011 and 2023. Patients were divided into two groups: those who underwent scheduled IS exchange (scheduled group, n = 12) and those who received on-demand IS exchange (on-demand group, n = 29). We compared unplanned hospitalization duration and number, time from initial IS placement to cholangitis onset, 1-year cholangitis-free rate from initial IS placement, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, and prognosis.
RESULTS: Median duration of unplanned hospitalizations was significantly shorter in the scheduled group compared to the on-demand group (0 days [range: 0-83] vs. 38.5 days [0-140], p = 0.03). The time from initial IS placement to the onset of cholangitis was also significantly longer in the scheduled group (median 203 days [range: 54-463] vs. 89 days [4-1081], p = 0.02). The 1-year cholangitis-free rate was significantly higher in the scheduled group (50% vs. 10%, p = 0.01). No significant differences were found in the number of unplanned hospitalizations, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, or prognosis.
CONCLUSIONS: Scheduled IS exchange delays the onset of cholangitis and reduces the duration of unplanned hospitalizations without increasing adverse events.