Safely increasing nephro-ureteric stent exchange intervals, resulting in significant cost savings for the interventional radiology suite, a 2-year experience in a tertiary referral centre

Aim To evaluate the nephro-ureteric stent (NUS) insertion and exchange practice in a tertiary referral cancer centre, and determine the safety and compliance with current guidelines. We also reviewed if increasing exchange time interval from 6 to 12 weeks was safe, and if this could be adopted into our local guidelines. Methods A retrospective review was performed covering 24 months from January 2017 to December 2018. All NUS insertions and exchanges performed in that period were analysed, including the number of exchanges the patient underwent, the time between subsequent exchanges, and the screening time. We also reviewed the indications for stent insertion, possible causes for failed stent exchange, and factors which led to significant delays in stent exchanges for some patients. A scatterplot of screening time versus time in situ was derived and correlation analysis performed using the Pearson coefficient. Results Thirty-two patients underwent de novo NUS insertion during the period, and 102 NUS exchanges were performed. The interval between stent exchanges ranged from 1 to 40 weeks, with a mean of 12.3 weeks (SD = 8.96 weeks). Screening time ranged from 33 s to 17 min, with a mean of 3 min 50 s (SD = 3 min 35 s). There were 100 successful exchanges, and two failed exchanges, accounting for 1.9% of total exchanges. In both failed cases, the reason for failed exchange was due to a prolonged period between exchanges (6 months in both cases). The reason for delay for stent exchange was due to non-attendance for scheduled appointments. There was a weakly positive correlation coefficient of 0.06 (screening time versus time period between insertions); however, this was not statistically significant (p = 0.81). Conclusion In this retrospective review, we have demonstrated that the recommended 6-week period between stent exchanges is unnecessary in the vast majority of cases, and that a longer interval between NUS exchanges, e.g. 8–12 weeks, is safe for the patient, and reduces screening time. This reduction in procedures also provides a significant potential saving to the radiology department in both monetary expense and limited angiography suite time.

Bilateral Encrusted Metallic Stent Successfully Removed by Ureteroscopic Lithotripsy Using a Ho:YAG Laser in a Patient with Malignant Myeloma

Ureteral stent encrustation is sometimes encountered, especially in cases in which a ureteral stent has been forgotten. An 84-year-old female patient with malignant myeloma underwent metallic ureteral stent insertion to treat malignant ureteral obstruction. At the time of scheduled ureteral stent exchange, the stent was heavily encrusted and could not be removed on either side. We performed endoscopic lithotripsy to remove the encrusted ureteral stents. The bilaterally encrusted metallic ureteral stents were successfully removed using Ho:YAG laser lithotripsy after inserting another ureteral stent placement besides the encrusted metallic ureteral stents.

Biodegradable Pancreatic and Biliary Stents—Still Searching For Disappearing Wonder?

Biodegradable stents hold considerable promise in the treatment of benign biliary or pancreatic diseases with the major advantage being avoidance of repeated interventions for stent removal or stent exchange. They have been confirmed to have good biocompatibility and current evidence shows acceptable rates of clinical efficacy and safety. In the current news and views, we discuss an interesting study that has evaluated a new type of biodegradable biliary and pancreatic stent (the Archimedes stent) in benign biliary and pancreatic diseases.

Endoscopic Necrosectomy of Walled-Off Necrosis following Severe Pancreatitis Using a Hot AxiosTM Stent – A Case Series

Background: Walled-off necrosis is a common complication of severe pancreatitis. Guidelines recommend endoscopic transgastric necrosectomy as therapy of choice. Different endoscopic approaches are possible. Methods: We retrospectively analyzed our series of 9 patients where necrosectomy was performed after application of a lumen-apposing metal stent (LAMS) delivered using a Hot AxiosTM Stent device. Results: In all 9 cases, the walled-off necrosis resolved completely. Necrosectomy was performed through the LAMS (mean: 5.7 times). Endoscopic necrosectomy was repeated every 3rd–7th day using 10- or 15-mm snares. There were no major complications. Especially, no early or delayed bleeding was seen. Conclusion: The Hot AxiosTM Stent device is a safe method for necrosectomy of walled-off necrosis. It enables puncture, drainage, and LAMS insertion in a single delivery, followed by several courses of necrosectomy if needed without stent exchange.

Sequential multistenting protocol in biliary stenosis after liver transplantation: a prospective analysis

Background Biliary complications are a serious source of morbidity after orthotopic and living-related liver transplantation. Endoscopic retrograde cholangiography (ERC) is the gold standard for patients with duct-to-duct anastomosis because it allows a direct approach for interventional procedures. A retrospective study showed results of a sequential multistenting protocol, without stent removal/exchange, with promising results. We conducted a prospective analysis to assess the clinical success, recurrence rate, and adverse event rate related to this protocol. Methods From May 2012 to April 2018, all consecutive patients with a diagnosis of anastomotic stenosis following liver transplantation were enrolled in the study, and were followed for a period of at least 6 months after the last ERC. During the first ERC, a maximum number of plastic stents (10 Fr) were placed. In subsequent ERCs, scheduled every 3 months up to a maximum of 1 year, additional stents were inserted, as many as possible, without removing the previously placed stents. Results From May 2012 to May 2018, 87 patients were included in the study and treated with a sequential multistenting protocol. The mean number of stents placed was 3.7 (SD 1.0). Clinical success (stricture resolution and normalization of cholestasis) was achieved in 86 patients (98.9 %). Seven patients (8.0 %) developed complications. Recurrence was recorded in seven patients (8.0 %) after a mean of 992.7 days (SD 622.1). Conclusions This study represents the first prospective demonstration of the efficacy and safety of a sequential multistenting protocol. A key limitation of the study is the lack of a comparative group treated according to the traditional stent exchange approach.