Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction: Biliary stent placement is a critical palliative treatment for obstructive jaundice due to malignancies. The site of these stents, either supra-ampullary (above the ampulla of Vater) or trans-ampullary (across or through the ampulla of Vater), may influence complication rates, notably infections, which significantly impact patient outcomes. This study evaluates the infection and obstruction rates associated with these two distinct stent placement strategies, as well as the significance of patient and procedural characteristics. Methods: Data from 66 patients who underwent biliary stent placements between January 2017 and December 2022 at our institution were analysed. Patients were categorised into two groups based on the stent placement: supra-ampullary (12 patients) and trans- ampullary (54 patients). According to a prescribed criteria, we assessed the incidence of clinical infections within 30 and 90 days post-procedure and in these patients evidence of radiological stent obstruction. Furthermore, patient age, gender and laterality of first puncture was examined. Testing for significant differences between categorical study parameters and study groups was conducted using chi-sq tests. Results: In the supra-ampullary group, infection rates were 41.67% within 30 days and 58.33% within 90 days post-procedure. In contrast, the trans-ampullary group exhibited infection rates of 12.96% within 30 days and 20.37% within 90 days. Higher infection rates were observed in the supra-ampullary group at 30 days, and this difference was statistically significant (P = 0.020). The difference in infection rates at 90 days was also statistically significant (P = 0.008). However, assessment of stent patency was not investigated in all cases, therefore an analysis of statistical significant at 90 days was not performed. There was no statistical significance associated with patient age, gender or laterality of first puncture. Conclusion: Our analysis indicates that supra-ampullary stent placements are associated with higher rates of post-procedural infections compared to trans- ampullary placements, with a statistically significant difference observed at both 30- and 90-days post-procedure. These findings undercore the importance of selecting optimal stent palcement strategies to reduce infection rates and improve patient outcomes. Further research with larger patient cohorts is necessary to confirm these findings and optimise clinical practices. Keywords: jaundice, biliary stent, supra-ampullary, trans-ampullary, infection rates, stent obstruction, interventional radiology.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402647364