Clinical impact of delayed plastic biliary stent removal because of the COVID-19 pandemic: the experience from a tertiary ERCP referral center

Background and Aims

Plastic biliary endoprosthesis is widely used because of its high efficacy and low cost. Delays in the removal or exchange of plastic biliary stents may lead to stent occlusion and subsequent sepsis,^1,2 with consensus recommendation of stent removal or exchange within 3 months.^3-7 We postulated that delayed plastic biliary stent removal observed during the pandemic would increase stent-related adverse events. We aim to report our single-center experience with adverse events arising from delayed plastic biliary stent removal.

Methods

All individuals who had ERCP-guided plastic biliary stent placement in the Queen Elizabeth II Health Sciences Center hospital in Halifax, Nova Scotia, between December 2019 and March 2022 were included. Stent lifespan was defined as days between stent deployment and removal. Kaplan-Meier survival analysis was used to represent the duration of stent patency. Only 10F-diameter stents were studied. Linear regression was used to analyze possible predictors of stent-related adverse events.

Results

In total, 286 cases were analyzed, of which 187 had delayed stent removal. Overall, 216 stents were removed without adverse events; 21 cases required urgent reintervention for adverse events; and in 26 cases, patients died of non-stent-related causes. Twenty-one stents had fully migrated out without causing adverse events. There was no difference in overall adverse events between the nondelayed versus delayed groups (23.2% vs 21.4%; odds ratio [OR], 0.899). Stent adverse events and emergent removal were marginally increased, at an OR of 1.21 and OR of 1.18, respectively, in indications related to stone disease.

Conclusions

A significant increase was not observed in stent-related adverse events in individuals with stents removed after 90 days. Plastic biliary stent longevity may be longer than previously thought. Our findings suggest that the majority of inserted plastic biliary stents remain patent up to 6 months without adverse outcomes. Larger studies are required to better characterize other predictors of biliary stent obstruction.