Letters to the editor
We thank Drs Ustundag & Saritas for their letter [1]. The aim of our study [2] was to evaluate the best management with plastic stents to prevent cholangitis in patients with biliary stones unfit for elective treatment. Therefore the study was designed for this purpose. Our patients were elderly; in this group acute cholangitis shows a high incidence of severe cholangitis. In such conditions the mortality rate is about 10 % [2]. Therefore it is very important to determine the optimal strategy for stent management. Our results showed that, in patients with bile duct stones treated by biliary stenting, the best way to avoid cholangitis was
Competing interests: None
References 1 Ustundag Y, Saritas U. A comparative analysis of plastic biliary stenting on demand or every 3 months for irretrievable bile duct stone disease [letter]. Endoscopy 2014: 46 2 Di Giorgio P, Manes G, Grimaldi E et al. Endoscopic plastic stenting for bile duct stones: stent changing on demand or every 3 months. A prospective comparison study. Endoscopy 2013; 45: 1014 – 1017 3 Rahman SH, Larvin M, McMahon MJ et al. Clinical presentation and delayed treatment of cholangitis in older people. Dig Dis Sci 2005; 50: 2207 – 2210
Pietro Di Giorgio, MD Department of Gastroenterology Ospedale Loreto-Mare Via Colombo Napoli 80130 Italy Fax: +39-81-2542742 [email protected] Downloaded by: Rutgers University. Copyrighted material.
Pietro Di Giorgio Reply to Ustundag & Saritas
to change the plastic stents at defined intervals (every 3 months). We have to consider that, in older patients, clinical presentation and routine laboratory sampling are not useful for making an early diagnosis. It is true that this strategy entails a greater number of ERCP procedures, but changing a stent is a very simple procedure with no morbidity or mortality in our experience. We did not enrol enough patients to demonstrate a significant difference in mortality between the two groups but that was not the goal of the study. As we noted in the Discussion section of our paper, “there is no doubt that we need further studies , including cost analyses, in order to evaluate which kind of stent would be better.”
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Endoscopy 2014; 46: 627
We thank Drs Ustundag & Saritas for their letter [1]. The aim of our study [2] was to evaluate the best management with plastic stents to prevent cholangitis in patients with biliary stones unfit for elective treatment. Therefore the study was designed for this purpose. Our patients were elderly; in this group acute cholangitis shows a high incidence of severe cholangitis. In such conditions the mortality rate is about 10 % [2]. Therefore it is very important to determine the optimal strategy for stent management. Our results showed that, in patients with bile duct stones treated by biliary stenting, the best way to avoid cholangitis was
Competing interests: None
References 1 Ustundag Y, Saritas U. A comparative analysis of plastic biliary stenting on demand or every 3 months for irretrievable bile duct stone disease [letter]. Endoscopy 2014: 46 2 Di Giorgio P, Manes G, Grimaldi E et al. Endoscopic plastic stenting for bile duct stones: stent changing on demand or every 3 months. A prospective comparison study. Endoscopy 2013; 45: 1014 – 1017 3 Rahman SH, Larvin M, McMahon MJ et al. Clinical presentation and delayed treatment of cholangitis in older people. Dig Dis Sci 2005; 50: 2207 – 2210
Pietro Di Giorgio, MD Department of Gastroenterology Ospedale Loreto-Mare Via Colombo Napoli 80130 Italy Fax: +39-81-2542742 [email protected] Downloaded by: Rutgers University. Copyrighted material.
Pietro Di Giorgio Reply to Ustundag & Saritas
to change the plastic stents at defined intervals (every 3 months). We have to consider that, in older patients, clinical presentation and routine laboratory sampling are not useful for making an early diagnosis. It is true that this strategy entails a greater number of ERCP procedures, but changing a stent is a very simple procedure with no morbidity or mortality in our experience. We did not enrol enough patients to demonstrate a significant difference in mortality between the two groups but that was not the goal of the study. As we noted in the Discussion section of our paper, “there is no doubt that we need further studies , including cost analyses, in order to evaluate which kind of stent would be better.”
627
Endoscopy 2014; 46: 627
