Comparative Analysis of Infection Rates Between Supra-Ampullary and Trans-Ampullary Biliary Stent Placements in Biliary Sepsis.

INTRODUCTION

Biliary stent placement is a critical palliative treatment for obstructive jaundice due to malignancies. The site, either supra-ampullary (above the ampulla of Vater) or trans-ampullary (below the ampulla of Vater), may influence complication rates which significantly impact patient outcomes. This study evaluates the infection and obstruction rates associated with these two distinct stent placement strategies.

METHODS

Data from 66 patients who underwent biliary stent placements between 2017 and 2022 at our institution were analysed. Patients were categorised into two groups based on stent placement: supra-ampullary (12 patients) and trans-ampullary (54 patients). We assessed the incidence of infection within 30 and 90 days post-procedure and in these patients evidence of radiological stent obstruction.

RESULTS

In the supra-ampullary group, infection rates were 41.67% within 30 days and 58.33% within 90 days post-procedure. The trans-ampullary group exhibited infection rates of 12.96% within 30 days and 20.37% within 90 days. Higher infection rates were observed in the supra-ampullary group at 30 days, and this difference was statistically significant (p = 0.020). The difference in infection rates at 90 days was also statistically significant (p = 0.008). In cases of infection where stent patency was investigated, radiologically confirmed stent obstructions (either stenosis or occlusion) within 90 days were not statistically significant (p = 0.296).

CONCLUSION

Supra-ampullary stent placements are associated with higher rates of post-procedural infections compared to trans-ampullary placements at both timepoints, highlighting the importance of selecting optimal stent placement strategies to reduce infection rates and improve patient outcomes.