Longterm follow-up of biliary stents for retained common bile duct stones in elderly patients

摘要

Common bile duct (CBD) stones in elderly patients are best treated by endoscopic sphincterotomy (ES). If CBD clearance cannot be achieved endoscopically a biliary stent may be inserted. Although satisfactory short-term results have been reported, few reports on their longterm outcome are available. Over a 3-year period, January 1987 to December 1989, 100 patients with CBD stones were referred for endoscopic stone removal. In 14 of these patients (3 men, 11 women; median age 83 years, range 79-97 years) the CBD could not be cleared endoscopically and a stent was inserted. Twelve of the 14 patients were jaundiced and 5 had acute cholangitis (AC). The maximum diameter of the retained stones ranged from 10-42 mm with a median of 17 mm. Stent insertion resolved jaundice and sepsis in all cases and all patients were discharged from hospital. In-patient stay ranged from 1-82 days (median 12 days) and was significantly increased by the presence of acute cholangitis (P=0.03, Mann-Whitney U-test). Longterm follow-up was obtained in 13 of the 14 patients (93%) by referral to their general practitioner and out-patient notes. Seven patients are alive and well (median follow-up 43 months, range 34-60 months). One of these 7 developed further jaundice owing to stent migration and had further ES and stone removal. Six patients died at 1, 3,12,32, 36 and 42 months following stent insertion from unrelated causes. One patient developed further AC requiring antibiotic treatment and another patient required stent replacement. Stenting of CBD stones in elderly patients is safe and effective in the short-term but is associated with further biliary problems in 25% of cases on longterm follow-up.