Impact of infected stent removal on recurrent cholangitis with time-to-event analysis
Background The optimal approach at treating infected biliary stents at the time of cholangitis remains unknown. This study aims to compare the efficacy of stent exchange versus stent sweeping/stent-in-stent approaches at treating cholangitis. Methods The study was a retrospective cohort study. Patie...
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| Veröffentlicht in: | Surgical endoscopy 2019-12, Vol.33 (12), p.4109-4115 |
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| creator | Jirapinyo, Pichamol AlSamman, Mohd Amer Thompson, Christopher C. |
| description | Background
The optimal approach at treating infected biliary stents at the time of cholangitis remains unknown. This study aims to compare the efficacy of stent exchange versus stent sweeping/stent-in-stent approaches at treating cholangitis.
Methods
The study was a retrospective cohort study. Patients with biliary stents and cholangitis were included. Outcomes were rate of recurrent cholangitis and time to recurrent cholangitis in those whose stents were left in place (stent sweeping and stent-in-stent) compared to those whose stents were removed (stent exchange). Primary analysis included patients with metal biliary stents only. Secondary analysis included those with metal and plastic biliary stents.
Results
A total of 182 patients (age 64 ± 12;89 F) with a metal biliary stent(s) at index cholangitis were included. Of these, 40 (22%) had stents removed, i.e., stent exchange. The remaining 142 (78%) did not have stent removal (97 with stent-in-stent and 45 with stent sweeping). Recurrent cholangitis occurred in 22.5% and 42.3% in the stent removal and non-removal groups, respectively (
p
= 0.02). Stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (OR 0.39,
p
= 0.03). Median time from index cholangitis to recurrent cholangitis was shorter for patients whose stents were not removed compared to those whose stents were removed (182 vs 450 days,
p
= 0.011). On Cox regression model, stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (HR 0.41,
p
= 0.01). The findings persisted in the secondary analysis including both metal and plastic biliary stents (303 patients).
Conclusion
Biliary stent removal with stent exchange at the time of cholangitis appears to be more effective at preventing recurrent cholangitis than leaving an infected stent in the biliary system. |
| doi_str_mv | 10.1007/s00464-019-06714-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6800825</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2200779542</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-22b9fe4e78adb2cff445b8b7d34f6fecaabb4c16bab49ee345e6ecbca5051c873</originalsourceid><addsrcrecordid>eNp9kUtPxCAUhYnR6Pj4Ay5MEzduqkBpKRsTM_GVmLhx1gSY2xlMW0agY_z3Mo6Oj4UrbrjfPZzLQeiY4HOCMb8IGLOK5ZiIHFecpGoLjQgraE4pqbfRCIsC55QLtof2Q3jGiRek3EV7BRaUE8pHaHLfLZSJmWsy2zdgIkyzEKGPmYfOLVWbuT6VZvB-dWnmrlX9zEYbslcb51m0HeTR5bBctVWv2rdgwyHaaVQb4OjzPECTm-un8V3-8Hh7P756yA3jLCabWjTAgNdqqqlpGsZKXWs-LVhTJTNKac0MqbTSTAAUrIQKjDaqxCUxNS8O0OVadzHoDqYmefCqlQtvO-XfpFNW_u70di5nbimrGuOalkng7FPAu5cBQpSdDQbatCS4IUhK00dzUTKa0NM_6LMbfFo4UUSIitCCrATpmjLeheCh2ZghWK5Sk-vUZEpNfqQmcRo6-bnGZuQrpgQUayCkVj8D__32P7LvC_-lmA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2199612315</pqid></control><display><type>article</type><title>Impact of infected stent removal on recurrent cholangitis with time-to-event analysis</title><source>SpringerLink Journals</source><creator>Jirapinyo, Pichamol ; AlSamman, Mohd Amer ; Thompson, Christopher C.</creator><creatorcontrib>Jirapinyo, Pichamol ; AlSamman, Mohd Amer ; Thompson, Christopher C.</creatorcontrib><description>Background
The optimal approach at treating infected biliary stents at the time of cholangitis remains unknown. This study aims to compare the efficacy of stent exchange versus stent sweeping/stent-in-stent approaches at treating cholangitis.
Methods
The study was a retrospective cohort study. Patients with biliary stents and cholangitis were included. Outcomes were rate of recurrent cholangitis and time to recurrent cholangitis in those whose stents were left in place (stent sweeping and stent-in-stent) compared to those whose stents were removed (stent exchange). Primary analysis included patients with metal biliary stents only. Secondary analysis included those with metal and plastic biliary stents.
Results
A total of 182 patients (age 64 ± 12;89 F) with a metal biliary stent(s) at index cholangitis were included. Of these, 40 (22%) had stents removed, i.e., stent exchange. The remaining 142 (78%) did not have stent removal (97 with stent-in-stent and 45 with stent sweeping). Recurrent cholangitis occurred in 22.5% and 42.3% in the stent removal and non-removal groups, respectively (
p
= 0.02). Stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (OR 0.39,
p
= 0.03). Median time from index cholangitis to recurrent cholangitis was shorter for patients whose stents were not removed compared to those whose stents were removed (182 vs 450 days,
p
= 0.011). On Cox regression model, stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (HR 0.41,
p
= 0.01). The findings persisted in the secondary analysis including both metal and plastic biliary stents (303 patients).
Conclusion
Biliary stent removal with stent exchange at the time of cholangitis appears to be more effective at preventing recurrent cholangitis than leaving an infected stent in the biliary system.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-019-06714-0</identifier><identifier>PMID: 30927127</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Chemotherapy ; Cholangitis ; Diabetes ; Gastroenterology ; Gynecology ; Hepatology ; Medicine ; Medicine & Public Health ; Proctology ; Stents ; Surgery</subject><ispartof>Surgical endoscopy, 2019-12, Vol.33 (12), p.4109-4115</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019</rights><rights>Surgical Endoscopy is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-22b9fe4e78adb2cff445b8b7d34f6fecaabb4c16bab49ee345e6ecbca5051c873</citedby><cites>FETCH-LOGICAL-c474t-22b9fe4e78adb2cff445b8b7d34f6fecaabb4c16bab49ee345e6ecbca5051c873</cites><orcidid>0000-0002-6105-5270</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-019-06714-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-019-06714-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30927127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jirapinyo, Pichamol</creatorcontrib><creatorcontrib>AlSamman, Mohd Amer</creatorcontrib><creatorcontrib>Thompson, Christopher C.</creatorcontrib><title>Impact of infected stent removal on recurrent cholangitis with time-to-event analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The optimal approach at treating infected biliary stents at the time of cholangitis remains unknown. This study aims to compare the efficacy of stent exchange versus stent sweeping/stent-in-stent approaches at treating cholangitis.
Methods
The study was a retrospective cohort study. Patients with biliary stents and cholangitis were included. Outcomes were rate of recurrent cholangitis and time to recurrent cholangitis in those whose stents were left in place (stent sweeping and stent-in-stent) compared to those whose stents were removed (stent exchange). Primary analysis included patients with metal biliary stents only. Secondary analysis included those with metal and plastic biliary stents.
Results
A total of 182 patients (age 64 ± 12;89 F) with a metal biliary stent(s) at index cholangitis were included. Of these, 40 (22%) had stents removed, i.e., stent exchange. The remaining 142 (78%) did not have stent removal (97 with stent-in-stent and 45 with stent sweeping). Recurrent cholangitis occurred in 22.5% and 42.3% in the stent removal and non-removal groups, respectively (
p
= 0.02). Stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (OR 0.39,
p
= 0.03). Median time from index cholangitis to recurrent cholangitis was shorter for patients whose stents were not removed compared to those whose stents were removed (182 vs 450 days,
p
= 0.011). On Cox regression model, stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (HR 0.41,
p
= 0.01). The findings persisted in the secondary analysis including both metal and plastic biliary stents (303 patients).
Conclusion
Biliary stent removal with stent exchange at the time of cholangitis appears to be more effective at preventing recurrent cholangitis than leaving an infected stent in the biliary system.</description><subject>Abdominal Surgery</subject><subject>Chemotherapy</subject><subject>Cholangitis</subject><subject>Diabetes</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Stents</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUtPxCAUhYnR6Pj4Ay5MEzduqkBpKRsTM_GVmLhx1gSY2xlMW0agY_z3Mo6Oj4UrbrjfPZzLQeiY4HOCMb8IGLOK5ZiIHFecpGoLjQgraE4pqbfRCIsC55QLtof2Q3jGiRek3EV7BRaUE8pHaHLfLZSJmWsy2zdgIkyzEKGPmYfOLVWbuT6VZvB-dWnmrlX9zEYbslcb51m0HeTR5bBctVWv2rdgwyHaaVQb4OjzPECTm-un8V3-8Hh7P756yA3jLCabWjTAgNdqqqlpGsZKXWs-LVhTJTNKac0MqbTSTAAUrIQKjDaqxCUxNS8O0OVadzHoDqYmefCqlQtvO-XfpFNW_u70di5nbimrGuOalkng7FPAu5cBQpSdDQbatCS4IUhK00dzUTKa0NM_6LMbfFo4UUSIitCCrATpmjLeheCh2ZghWK5Sk-vUZEpNfqQmcRo6-bnGZuQrpgQUayCkVj8D__32P7LvC_-lmA</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Jirapinyo, Pichamol</creator><creator>AlSamman, Mohd Amer</creator><creator>Thompson, Christopher C.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6105-5270</orcidid></search><sort><creationdate>20191201</creationdate><title>Impact of infected stent removal on recurrent cholangitis with time-to-event analysis</title><author>Jirapinyo, Pichamol ; AlSamman, Mohd Amer ; Thompson, Christopher C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-22b9fe4e78adb2cff445b8b7d34f6fecaabb4c16bab49ee345e6ecbca5051c873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal Surgery</topic><topic>Chemotherapy</topic><topic>Cholangitis</topic><topic>Diabetes</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Stents</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jirapinyo, Pichamol</creatorcontrib><creatorcontrib>AlSamman, Mohd Amer</creatorcontrib><creatorcontrib>Thompson, Christopher C.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jirapinyo, Pichamol</au><au>AlSamman, Mohd Amer</au><au>Thompson, Christopher C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of infected stent removal on recurrent cholangitis with time-to-event analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>33</volume><issue>12</issue><spage>4109</spage><epage>4115</epage><pages>4109-4115</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
The optimal approach at treating infected biliary stents at the time of cholangitis remains unknown. This study aims to compare the efficacy of stent exchange versus stent sweeping/stent-in-stent approaches at treating cholangitis.
Methods
The study was a retrospective cohort study. Patients with biliary stents and cholangitis were included. Outcomes were rate of recurrent cholangitis and time to recurrent cholangitis in those whose stents were left in place (stent sweeping and stent-in-stent) compared to those whose stents were removed (stent exchange). Primary analysis included patients with metal biliary stents only. Secondary analysis included those with metal and plastic biliary stents.
Results
A total of 182 patients (age 64 ± 12;89 F) with a metal biliary stent(s) at index cholangitis were included. Of these, 40 (22%) had stents removed, i.e., stent exchange. The remaining 142 (78%) did not have stent removal (97 with stent-in-stent and 45 with stent sweeping). Recurrent cholangitis occurred in 22.5% and 42.3% in the stent removal and non-removal groups, respectively (
p
= 0.02). Stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (OR 0.39,
p
= 0.03). Median time from index cholangitis to recurrent cholangitis was shorter for patients whose stents were not removed compared to those whose stents were removed (182 vs 450 days,
p
= 0.011). On Cox regression model, stent removal remained a negative predictor of recurrent cholangitis after controlling for age, sex, history of diabetes, and chemotherapy (HR 0.41,
p
= 0.01). The findings persisted in the secondary analysis including both metal and plastic biliary stents (303 patients).
Conclusion
Biliary stent removal with stent exchange at the time of cholangitis appears to be more effective at preventing recurrent cholangitis than leaving an infected stent in the biliary system.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30927127</pmid><doi>10.1007/s00464-019-06714-0</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6105-5270</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2019-12, Vol.33 (12), p.4109-4115 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6800825 |
| source | SpringerLink Journals |
| subjects | Abdominal Surgery Chemotherapy Cholangitis Diabetes Gastroenterology Gynecology Hepatology Medicine Medicine & Public Health Proctology Stents Surgery |
| title | Impact of infected stent removal on recurrent cholangitis with time-to-event analysis |
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