Proksimale Migrate Biliyer Plastik Stentlerin Yönetimi: Tek Merkez Deneyimi

Öz

Giriş ve Amaç: Biliyer stentlerin migrasyonu beklenmeyen komplikasyonlardan biridir. Proksimale migre olan stentler ciddi komplikasyonlara yol açabileceğinden, yönetimleri önemlidir. Bu çalışmada proksimale migre stent saptadığımız hastalarımızı değerlendirmek ve güncel medikal literatürü gözden geçirmeyi amaçladık. Gereç ve Yöntem: Eylül 2017-Kasım 2022 tarihleri arasında Sağlık Bilimleri Üniversitesi Adana Şehir Eğitim ve Araştırma Hastanesinde endoskopik retrograd kolanjiopankreatografi işlemi yapılan hastalar çalışmaya alındı. Hastaların dosyaları ve hastane veri tabanı retrospektif olarak tarandı. Hastaların klinik ve laboratuvar verileri kaydedildi. Bulgular: Çalışmaya 57 hasta alındı. Ortalama yaş 60.7 ± 14.5 (29-90) ve 30 (52.6%) hasta erkek idi. Otuz dört hasta başvuru anında asemptomatik, diğer hastalarda ise karın ağrısı, sarılık veya ateş şikayetleri vardı. On beş (%26.3) hastada kolanjit ve beş hastada başvuru sırasında karaciğer apsesi mevcuttu. Bir hasta proksimale migre stent ile ilişkili kolanjit nedeniyle hayatını kaybetti. Otuz bir hastada proksimale migre stentler hastanemizde başarılı bir şekilde çıkarıldı. Stent çıkarılması sonrası iki hastada endoskopik retrograd kolanjiopankreatografi işlemi sonrası komplikasyon gelişti (Bir hastada post endoskopik retrograd kolanjiopankreatografi pankreatiti ve bir hastada kanama). Dört hastada cerrahi girişim yapıldı. Dokuz hastada migre olmuş stentler dış merkezde çıkarıldı. On üç hastada migre olmuş stentler çıkarılamadı. Sonuç: Proksimale migre olmuş biliyer stentler biliyer stentlerin önemli bir komplikasyonudur. Hastalar semptomatik veya asemptomatik olabilir. Proksimale migre olmuş biliyer stentler kolanjit, karaciğer apsesi ve hatta ölüme bile yol açabilirler. Bu nedenle erken tanı ve uygun tedavi önemlidir. Proksimale migre olmuş biliyer stentler endoskopik retrograd kolanjiopankreatografi işlemi ile çıkarılabilirler.

Anahtar Kelimeler

• Biliyer stent
• proksimal migrasyon
• tedavi

Management of Proximal Migrated Biliary Stents: Single Center Experience

Öz

Background and Aims: Migration in biliary stents is one of the expected complications of biliary stenting. Since proximally migrated biliary stents may result in serious complications, management of proximally migrated biliary stents are important. In this study we aimed to evaluate our patients with proximally migrated biliary stents and review current medical literature. Materials and Methods: Patients with proximally migrated biliary stents who had endoscopic retrograde cholangiopancreatography application at Health Sciences University, Adana City Training and Research Hospital, Department of Gastroenterology between September 2017- November 2022 were included in the study. Patients’ files and electronic database of our hospital were screened and evaluated retrospectively. Patients’ clinic and laboratory data were recorded. Results: The study included 57 patients. Mean age was 60.7 ± 14.5 (29-90) and 30 (52.6%) were male. Thirty four patients were asymptomatic other remaining patients presented with abdominal pain, jaundice, or fever. Fifteen (26.3%) patients had cholangitis and five patients had liver abscess during presentation. One patient died due to cholangitis associated with proximally migrated biliary stents. In 31 patients, proximally migrated biliary stents were removed successfully in our hospital. After stent removal, two patients had post-endoscopic retrograde cholangiopancreatography complications (post-endoscopic retrograde cholangiopancreatography pancreatitis and bleeding). Four patients had surgical intervention. In nine patients, stents were removed in external centers. In 13 patients, proximally migrated biliary stents could not be extracted. Conclusions: Proximal migration of biliary stents is an important complication of biliary stenting. Patients may be asymptomatic or symptomatic. Proximally migrated biliary stents may result in serious complications such as cholangitis, liver abscess and even death. Thus, early diagnosis and proper treatment are important in these patients. Proximally migrated biliary stents may be removed in most patients with endoscopic retrograde cholangiopancreatography.

Anahtar Kelimeler

• Biliary stent
• proximal migration
• treatment

Kaynakça

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