Influencing factors for stent obstruction after endoscopic retrograde biliary drainage in patients with refractory common bile duct stones / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the influencing factors for stent obstruction after endoscopic retrograde biliary drainage (ERBD) for refractory common bile duct stones. MethodsA total of 126 patients who underwent ERBD for refractory common bile duct stones in Renmin Hospital of Wuhan University from January 2014 to May 2019 and were readmitted for stent removal at 6 months after surgery were enrolled, and according to the condition of stent removal, they were divided into obstruction group and unobstructed group. General data and related indices were compared between the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was used to investigate the influencing factors for stent obstruction after surgery. ResultsAmong the 126 patients, 28 were found to have stent obstruction during removal, with a stent obstruction rate of 22.2%. The univariate analysis showed that there were significant differences between the two groups in white blood cell count (WBC), percentage of neutrophils (Neu%), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase, leucine aminopeptidase, endoscopic sphincterotomy (EST), infection, aspirin, and stent type (all P＜005). The multivariate logistic regression analysis showed that WBC［OR(95%CI)1.232(1.033-1.470)］, Neu%［OR(95%CI)1.263(1.021-1.562)］, ALP［OR(95%CI)1.013(1.004-1.022)］, EST［OR(95%CI)5.890(1.114-31.139)］, infection［OR(95%CI)17317(1.349-222.349)］, and stent type［OR(95%CI)0.144(0.022-0.937)］ were independent influencing factors for postoperative stent occlusion (all P＜0.05). ConclusionPatients with elevated WBC/Neu%/ALP, intraoperative EST, and preoperative secondary infection have a high risk of postoperative stent obstruction, and close follow-up and early prevention should be performed for such patients. The double pigtail stent can effectively reduce the rate of postoperative stent obstruction.