BILE-DUCT STENTS - IS THERE AN INCREASED RATE OF COMPLICATIONS IN PATIENTS RECEIVING CHEMOTHERAPY

The aim of this study was to determine whether palliative chemotherapy accelerates the rate of biliary stent occlusion, in patients with a m alignant biliary obstruction. Such treatment can induce neutropenia an d increase the risk of bacterial sepsis. Overgrowth of bacteria within the bile of patients receiving chemotherapy could accelerate the rate of stent occlusion. Retrospective analysis of treatment records for 8 0 consecutive patients with a diagnosis of adenocarcinoma arising from the pancreas, bile ducts or gall bladder was conducted. Two groups we re identified, those with a biliary stent in situ (primary stent group : 47/80; 59%) at the time of referral and those without (no stent grou p: 33/80; 41%). The majority of patients went on to receive chemothera py, 64% and 70% in the primary stent group and no stent group, respect ively. The rate of febrile neutropenia was similar in the two groups ( 5% versus 7% of all chemotherapy cycles in the primary stent group and no stent group, respectively). The rate of stent occlusion was not si gnificantly different between those exposed to chemotherapy (37%; 95% CI 20-54%) and those unexposed (39%; 95% CI 19-59%). Similarly, the me an duration of patency was not shortened by chemotherapy (105 days in the chemotherapy group versus 119 days in the non-chemotherapy group; P = 0.97, Mann-Whitney U-test). We conclude that there is no evidence of increased rate of bile duct-related complications in patients recei ving chemotherapy. In particular, we find no indication for the use of prophylactic antibiotics. (C) 1997 Elsevier Science Ltd.