High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance

Background and Study Aims: Biliary obstruction in chronic pancreatitis is f requently treated by endoscopic insertion of a plastic stent into the commo n bile duct, a therapy regarded as having a low complication rate. The aim of this study is to analyze the frequency and severity of complications cau sed by biliary stents in patients with chronic alcoholic pancreatitis. Patients and Methods: We retrospectively analyzed all our patients with chr onic pancreatitis (n = 14) who were provided with a plastic stent for bilia ry stenosis between June 1993 and December 1997, Stent exchanges were follo wed until December 1998, Results: Stent insertion was performed without early complications and was successful in each patient, Only two patients were admitted after 3-4 month s at the scheduled dates for stent exchange, both without complications, In one of these patients, the bile duct stenosis was reopened after two stent exchanges over a total period of 8 months, Most of our patients (n=12) did not come at the arranged dates for stent exchange, They were repeatedly ad mitted (mean 2.9 times/patient, range 1-5) as emergency cases with severe c omplications of biliary obstruction, such as cholangitis or biliary sepsis, Reopening of the bile duct stenosis was not achieved in these patients. Conclusions: We associate the high rate of complications with the noncompli ance of our patients, who were all alcoholics. The high incidence of late c omplications in noncompliant patients is a limitation of biliary stenting, and appears to be potentially harmful.