Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis

BackgroundCholangitis is a major complication after metallic stent placement to treat biliary obstruction, and it may impair quality of life. Whether transpapillary stent placement contributes cholangitis is still controversial.ObjectivesThe present study aimed to determine risk factors for acute cholangitis after metallic biliary stent placement.DesignRetrospective cases series.PatientsA total of 108 patients with malignant biliary obstruction were treated with metallic stents, resulting in 12 cases of cholangitis.Main Outcome MeasurementsA multiple logistic regression model was performed with clinical parameters, including stent placement across the main duodenal papilla.ResultsBy multiple logistic regression model, age; lower location; and Wallstent, Ultraflex stent, and covered stent were negatively associated with cholangitis. Restenosis and placement across the main duodenal papilla were positively associated with the occurrence of cholangitis. Transpapillary stent placement was the most significant risk factor. In this logistic model, the area under a receiver operating characteristics curve was computed as 0.92: sensitivity, 0.92 (95% confidential interval (CI), 0.62-1.00); specificity, 0.86 (95% CI, 0.78-0.93); positive predictive value, 0.46 (95% CI, 0.26-0.67); and negative predictive value, 0.99 (95% CI, 0.94-1.00).ConclusionsDisruption of the sphincter mechanism by transpapillary placement may be the most important etiologic factor in the propensity for cholangitis after metallic stent placement for malignant biliary obstruction.