Scheduled Inside Plastic Stent Exchange Prevents Cholangitis and Reduces Unplanned Hospitalization in Patients With Unresectable Malignant Hilar Biliary Obstruction.

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.