University of Missouri Kansas City School of Medicine Kansas City, MO
Introduction: Endoscopically placed common bile duct stents are used for biliary decompression. Studies have reported median patency of plastic stents between 77 to 126 days. It is advisable to remove or exchange these stents within three months of the index procedure to prevent complications such as stent occlusion, dysfunction, migration, and cholangitis. We hypothesized that the risk of retained biliary stents might be high in the underserved population owing to low socio-economic status, language and intellectual barriers, and demographical distribution.
Methods: A retrospective study was conducted amongst all patients who underwent ERCP-guided plastic biliary stent placement between January 2016 and December 2021 at our community-based institution. Charts were reviewed to collect demographics, index ERCP, removal/exchange procedure, complications, and follow-up office visits. Retained biliary stents were defined as patients who did not show up for their follow-up ERCP for stent removal (missed stent group) or those who presented for stent removal later than the recommended time frame of 3 months (Delayed stent removal group). Descriptive analysis was performed. Chi-square and Fisher exact tests were used to compare categorical variables and t-tests for continuous variables.
Results: A total of 431 ERCPs were performed, out of which 46 (10.7%) patients had retained stents. Fifty percent of the cohort (n=23) were white and 63% (n=29) were females. 10 patients (21.8%) were non-English speakers, and 10 patients (21.8%) were non-insured. 32 (69.6%) of the index ERCPs performed were done in the outpatient setting. Our ERCP reports stated the recommended follow-up time for stent removal for all patients whether performed in the inpatient or outpatient setting. However, 8/14 (57%) of the inpatients did not have these instructions included in their discharge summaries. No statistical significance was seen when comparing missed versus delayed stent removal groups, except for the ERCP location. (Table 1).
Discussion: Socio-economic and demographic factors, including the language barrier and lack of insurance as well as the absence of specific and clear follow-up dates on the discharge instructions from the hospital, could be associated with retained biliary stents.
