Long-term risk of cholangitis in patients with metal stents for malignant biliary obstruction

Background Patients with malignant biliary obstruction are commonly living longer than previously due to improved oncologic therapies, often exceeding expected times of self-expanding metal stent patency. Aims The purpose of this study was to assess the longterm risk and impact of cholangitis in these patients. Methods Retrospective review of electronic medical records at an academic medical center. Results One hundred and one patients had a selfexpanding metal stent placed for malignant biliary obstruction. The median survival after SEMS was 214 days. Of these patients, 22% developed at least one episode of cholangitis requiring inpatient admission, 20% (9/45) of patients were hospitalized for cholangitis at 6 months, 40% (8/20) at 1 year, and 75% (3/4) at 2 years. All of the (8/8) patients receiving chemotherapy prior to hospitalization for cholangitis experienced delays in subsequent chemotherapy. Follow-up of 36 episodes of cholangitis revealed a 14% 30-day mortality. Conclusions Cholangitis develops commonly in longterm survivors with self-expanding metal stents for malignant biliary obstruction, and is associated with delays in chemotherapy and a 14% 30-day mortality.