Risk factors of early dysfunction after switching from plastic to metal stents in malignant extrahepatic biliary obstruction

Q: How is early SEMS dysfunction defined in this study?

Early SEMS dysfunction is defined as dysfunction occurring within 90 days after SEMS placement.

Q: What is the reported rate and main causes of early SEMS dysfunction?

Among 56 patients, the early SEMS dysfunction rate was 30.1%. The main causes were nonspecific cholangitis (35.3%) and stent clogging (35.3%).

Q: Which factors independently predict early SEMS dysfunction?

Two independent predictors were identified: a history of short PS patency (<60 days) before SEMS insertion, and post-ERCP cholangitis following SEMS placement.

Sep 29, 2026

Uploaded by Emma Wilson

Study identifies predictors of early self-expandable metallic stent (SEMS) dysfunction in malignant extrahepatic biliary obstruction patients who first received plastic stents (PS) and then underwent SEMS placement. Retrospective analysis includes patients receiving first SEMS insertion after prior PS placement for distal extrahepatic malignant biliary obstruction between 2015 and 2021, defining early dysfunction as occurring within 90 days. Early dysfunction occurred in 30.1%, mainly due to nonspecific cholangitis and stent clogging; multivariate analysis shows short PS patency (<60 days) and post-ERCP cholangitis after SEMS placement as independent risks.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

J Chin MedAssoc Original article Risk factors of early dysfunction after switching from plastic to metal stents in malignant extrahepatic biliary obstruction Chia-Chia Lua, Chun-Fang Tungb,c, Yen-Chun Pengb,c, Yi-Jun Liaob,d, Hsin-Ju Tsaib,d, Sheng-Shun Yangb,d,e,f,g, Chia-Chang Chenb,d,f,* aDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan, ROC; bDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; cSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDepartment of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; eSchool of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC; fPh.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC; gInstitute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC Abstract Background: Patients diagnosed with extrahepatic malignant biliary obstruction (MBO) often initially undergo endoscopic retrograde biliary drainage with a plastic stent (PS) . Self-expandable metallic stents (SEMSs) have been shown to yield better outcomes than PS. This study aimed to identify predictors of early SEMS dysfunction in MBO patients who initially received PS and subsequently underwent SEMS placement. Methods: We retrospectively analyzed patients who received their first SEMS insertion following prior PS placement for distal extrahepatic MBO between January 2015 and December 2021. We also analyzed the possible risk factors for early SEMS dysfunction defined as occurring within 90 days. Results: Fifty-six patients who received their first SEMS for distal extrahepatic MBO were identified. The rate of early SEMS dysfunction was 30 . 1% . The main causes of early SEMS dysfunction were nonspecific cholangitis (35 .3%) and stent clogging (35 .3%) . Multivariate logistic regression analysis identified two independent predictors of early SEMS dysfunction: (a) a history of a short PS patency (<60 days), and (b) post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis following SEMS placement. The odds ratio (OR) for (a) was 10.77 (95% confidence interval [CI] 2.54 to 45.66, p = 0.001), and for (b) was (OR) 6.59 (CI 1.00–43.43, p = 0.050) . Conclusion: Two risk factors associated with early SEMS dysfunction in patients with extrahepatic MBO are short PS patency (<60 days) before SEMS insertion and the development of post-ERCP cholangitis following SEMS placement. Keywords: Biliary tract diseases; Cholestasis; Endoscopic retrograde; Extrahepatic; Self-expandable metallic stents Lay Summary: For patients with extrahepatic malignant biliary obstruction, endoscopic retrograde cholangiopancreatography (ERCP)-guided stenting helps drain obstructed bile ducts. Selfexpandable metallic stents (SEMS) generally perform better than plastic stents, especially in patients with a life expectancy greater than three months. However, a review of the literature shows that early SEMS dysfunction—defined as SEMS dysfunction within 90 days—affects 22.5–31% of cases, leading to treatment delays, reduced quality of life, and a higher risk of cholangitis. This *Address correspondence: Dr. Chia-Chang Chen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan Boulevard Section 4, Taichung 407, Taiwan, ROC. E-mail [address: judgespear@gmail.com](address: judgespear@gmail.com) (C.-C. Chen). Conflicts of interest: The authors declare they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 451-460. Received September 25, 2023; accepted January 1, 2025. doi: 10. 1097/JCMA.0000000000001234 Copyright © 2025, the

FAQs

How is early SEMS dysfunction defined in this study?

Early SEMS dysfunction is defined as dysfunction occurring within 90 days after SEMS placement.

What is the reported rate and main causes of early SEMS dysfunction?

Among 56 patients, the early SEMS dysfunction rate was 30.1%. The main causes were nonspecific cholangitis (35.3%) and stent clogging (35.3%).

Which factors independently predict early SEMS dysfunction?

Two independent predictors were identified: a history of short PS patency (<60 days) before SEMS insertion, and post-ERCP cholangitis following SEMS placement.

Sep 29, 2026

Uploaded by Emma Wilson