NEW YORK (Reuters Health) – Despite pandemic-imposed suspension of routine gastrointestinal endoscopic procedures, priority should be given to timely removal of stents following recovery in patients who undergo endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement, according to U.K. researchers.
In a new letter in Gut, Dr. Wafaa Ahmed and colleagues at King’s College Hospital, London, describe the harms they have observed as a result of pandemic-related delayed removal.
They note that in March 2020, the World Health Organization announced that in regard to endoscopy only life-threatening emergencies and severe conditions should merit consideration.
They add that endoscopic activity in the U.K. at one point during 2020 had fallen to as little as 5% of its pre-pandemic level, according to an earlier study (https://bit.ly/2MTjzMZ). This drop “resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis,” the authors of that study wrote.
But little attention has been given to patients with biliary-stent placement prior to pandemic-related restriction of endoscopic activities. Under normal circumstances, Dr. Ahmed and her colleagues say, many of those would have undergone endoprosthesis replacement or revision prior to potential endoscopic activity later.
The team recounts its experience in patients with fully covered self-expandable intraductal stents (Kaffes stents, TaeWoong Niti-S), which “have been increasingly deployed for the treatment of benign biliary obstruction, including post-transplant anastomotic strictures.”
The stents have a long platinum retrieval string that allows removal with grasping forceps or snare and this should be done within 12 weeks of placement.
However, in the five patients that Dr. Ahmed and her colleagues report on, removal was delayed for a median of eight months. This resulted in stent degradation with severe procedural complications.
In three patients, the platinum wires disintegrated when grabbed, with failure of the collapsing mechanism. Multiple attempts to remove the stent with various methods followed and finally the stents were extracted after the collapsed segment was grasped while still in the duct.
In the other two patients, it was apparent that tissue overgrowth had resulted in the stent being embedded. This necessitated dilatation of the segment below the stent.
These complications led to a median procedural time of more than two hours. Three patients needed additional analgesia and three required antibiotics. And although patients are normally admitted for overnight observation, one was hospitalized for two days and another for 12 days with purulent cholangitis.
Thus, the researchers suggest “that gastrointestinal endoscopy departments performing ERCP involving Kaffes stents should identify and prioritize removal of these stents in the recovery phase of endoscopic activity.” Extra procedure time should also be allocated “due to challenging stent removal with additional consent and discussion with the patient.”
Dr. Ahmed did not respond to requests for comments.
SOURCE: https://bit.ly/3tJIGSZ Gut, online February 1, 2021.
Source: Read Full Article