Endoscopic biliary drainage by 7 Fr or 10 Fr stent placement in patients with acute cholangitis.

Abstract

BACKGROUND AND STUDY AIMS:

Endoscopic biliary drainage is an established mode of treatment for acute cholangitis. We compared the safety and efficacy of 7 Fr and 10 Fr stent placement for biliary drainage in patients with acute cholangitis.

PATIENTS AND METHODS:

We recruited 40 patients with severe cholangitis who required endoscopic biliary drainage. Patients were randomized to have either a 7 Fr or a 10 Fr straight flap stent placement during endoscopy. Outcome measures included complications related to endoscopic retrograde cholangiopancreatography (ERCP) and clinical outcome.

RESULTS:

Of 40 patients, 20 were randomized to the 7 Fr stent group and 20 to the 10 Fr stent group. All patients had biliary obstruction due to stones in the common bile duct. Indications for biliary drainage were: fever >100.4 degrees F (n = 27), hypotension (n = 6), peritonism (n = 10), impaired consciousness (n = 8), and failure to improve with conservative management (n = 13). Biliary drainage was achieved in all patients. Abdominal pain, fever, jaundice, hypotension, peritonism, and altered sensorium improved after a median period of 3 days in both groups. Leukocyte counts became normal after a median time of 4 days in the 7 Fr stent group and 6 days in the 10 Fr stent group. There were no ERCP-related complications. There were no instances of occlusion or migration of stent. The success rates of biliary drainage in cholangitis were not affected by the size of stent used.

CONCLUSIONS:

Biliary drainage by 7 Fr stent or 10 Fr stent is equally safe and effective treatment for patients with severe cholangitis.

• Authors: B C Sharma, N Agarwal, P Sharma, S K Sarin
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 54 Issue 6 Pg. 1355-9 (Jun 2009) ISSN: 1573-2568 [Electronic] United States
• PMID: 18807184 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Acute Disease
• Adult
• Cholangitis (surgery)
• Drainage (methods)
• Endoscopy, Gastrointestinal
• Female
• Humans
• Male
• Middle Aged
• Stents