STENTING AS A DEFINITIVE PROCEDURE IN BENIGN BILIARY DISEASE

Objective: To assess the efficacy of biliary stent insertion for benig n disease. Design: A five year review of all patients who underwent en doscopic retrograde cholangio-pancreatography (ERCP). Those who had a stent inserted for benign biliary disease were retrospectively analyse d by chart review, family doctor contact and death certificate checkin g. Setting: A large district general hospital providing an ERCP servic e for 200,000 people. Patients: Thirty-one patients (mean age 75) were identified who had biliary endoprostheses inserted for unextractable stones (20) solitary structure (3) or both (8). Outcome: Complications requiring stent change and stent-related death were the clinical meas urements recorded, Serum bilirubin and alkaline phosphatase were also measured. Results: Ten (32%) patients died a mean of 12 months after t he procedure. One structure patient died from causes related to the bi liary tract, The remaining 21 patients were followed for a mean of 29 months and all are asymptomatic, Complications developed in 6 patients a structure being present at initial stenting in 5 of these six patie nts. Requirement for further procedures was statistically more frequen t in patients with structuring (45% v 5% p < 0.05), Although initially , no different alkaline phosphatase levels on latest follow-up were si gnificantly higher in patients who had a structure at initial ERCP (51 2 v 176 p < 0.005). Discussion: Stenting for unextractable biliary sto nes in patients judged unfit for surgery is a safe and effective proce dure. Stenting in the presence of biliary strictures carries a signifi cantly greater risk of future complications.