Analysis of complications after EUS-FNA in patients with obstructive jaundice and drained with plastic biliary stents or self-expandable metal stent (SEMS): do complications differ between the type of stent?
Mitesh Bhalala, Katie Rude, Andrew Wang, Bryan Sauer, Grace E White, Michel Kahaleh, Vanessa M Shami
The standard of care for relieving malignant obstructive jaundice is endoscopic biliary stenting. There is debate on use of plastic biliary stents vs. self-expanding metal stents (SEMS) for biliary decompression. While the latter is more expensive, it tends to have a longer patency. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) can be performed after biliary decompression for diagnostic and staging purposes. This retrospective study compares the complications of EUS-FNA in patients drained with plastic stents vs. SEMS.
Seventy-six patients underwent EUS-FNA after biliary stenting. 31 patients received plastic stents and 45 patients received SE MS. All 76 patients underwent EUS-FNA by dedicated pancreatico-biliary endoscopists. All immediate complications within 48 hours of the EUS-FNA were recorded. Complication rates were statistically compared between patients with plastic stents vs. SEMS.
A total of 76 patients with a mean age of 64.3 years were collected and analyzed retrospectively. 31 patients underwent plastic stenting and 45 patients underwent SE MS placement for biliary decompression for head of pancreas masses. A total of 4/31 patients had complications in the plastic stent group while 0/45 of patients had complications in the SE MS group (p=0.025). The complications in the plastic stent group were abdominal pain (n=2) and cholangitis (n=2).
This study suggests that EUS-FNA in patients who underwent biliary decompression with a plastic stent had significantly more complications than patients who underwent placement of a SEMS. We hypothesize that the smaller caliber biliary stent is more likely to occlude after FNA secondary to bleeding and/or edema.