Reflux of duodenal contents and cholangitis in patients undergoing self-expanding metal stent placement

Abstract

Background: It has been reported that the occurrence of acute cholangitis is common, especially when the self-expanding metal stent (SEMS) is placed across the main duodenal papilla.

Objective: To determine the incidence of duodenobiliary reflux and acute cholangitis after placement of SEMSs across the main duodenal papilla.

Design: A prospective study.

Setting: A tertiary-care teaching hospital.

Patients: One hundred consecutive patients with malignant bile-duct obstruction.

Interventions: A barium meal examination was performed 21 days after placement of SEMSs. Reflux of barium was monitored by using fluoroscopy. The patients were also monitored for the occurrence of fever. Serum bilirubin, alanine aminotransferase, alkaline phosphatase, and total and differential leukocyte counts were evaluated before and after the barium study.

Main outcome measurements: The occurrence of duodenobiliary reflux and acute cholangitis.

Results: Two patients developed acute cholangitis because of the failure of the function of the SEMS, and they died during the first week. Severe reflux of barium was evident in all the patients. However, none of them developed features of acute cholangitis because of reflux. After a mean (SD) follow-up of 6.4 +/- 1 months, 6 patients developed acute cholangitis because of blockage of the SEMS from ingrowth of tumor or collection of debris at the lower end of the SEMS.

Limitations: Unblinded study.

Conclusions: After placement of SEMSs across the main duodenal papilla, reflux of duodenal contents is a universal phenomenon. Acute cholangitis was observed only in cases with blockage of the SEMS from tumor ingrowth or debris.