How Much Pain Is Common After Ercp With Stent?

How Much Pain Is Common After Ercp With Stent
How much pain is common after ERCP with stent? – It’s caused by pain travelling along a nerve that goes to the liver. The referred pain usually lasts less than 12 hours. You may have a small amount of bleeding from the puncture site. You will need to take it easy at home for 1 to 3 days after the PTC.

How are migrated biliary stents removed? Most migrated stents can be removed endoscopically without the morbidity of surgery. Although most reports used a variety of techniques, some of the more commonly used were direct traction with a snare or forceps and indirect traction with a dilation or stone extraction balloon.

Can a biliary stent move? A straight biliary stent may migrate since there is nothing to hold it in place, even though there are side flaps. Inappropriately long stent may exert pressure on the duodenal wall causing tissue necrosis and perforation.

How common is severe pain after stent removal?

Severe pain after stent removal: How often does it happen and can anything prevent it? How Much Pain Is Common After Ercp With Stent Can a single pill prevent post stent removal pain? (Image from Office.com) Many patients complain of some pain after having a ureteral stent is removed. This pain is usually mild and self-limited. However, the pain can sometimes be severe. Because patients may not have been warned about the possibility of significant pain beforehand, it can come as an unwelcome surprise, and patients may be left wondering whether something is wrong.

  • Patients who are affected by this pain may describe it as being worse than their original stone pain.
  • In some cases the pain can be bad enough to bring them back to the emergency room.
  • Up to now, there hasn’t been much research on this topic and it was not clear how often this phenomenon occurs or what might be done to prevent it.

A recent publication in the journal BJU International now suggests that severe pain after stent removal may occur in as many as half (55%) of patients. In the study, performed by researchers at Oregon Health & Science University and the Portland Veterans Administration Medical Center, patients having their indwelling ureteral stents removed were either given a placebo pill or a single 50mg dose of the non-steroidal anti-inflammatory drug (NSAID) rofecoxib fifteen minutes before their stent removal procedure.

Patients were asked to report their pain just before and 24 hours after their stent removal on a scale ranging from 1 to 10, with 7 or above being considered severe pain. Six of the eleven patients (55%) given placebo developed severe pain after their stent removal while none of the ten patients given rofecoxib developed severe pain.

The authors speculated that the mechanism by which the NSAID medicine may have provided such a dramatic reduction in severe pain occurrence might have been through reducing ureteral spasms or by decreasing pressure within the kidney. While the results of the study are very encouraging, further research will be needed to confirm the findings.

  • For now though, the study is currently the only evidence we have on how often post stent removal severe pain occurs and what we might do to prevent it – take a single dose of a NSAID pain medication fifteen minutes before removing a stent.
  • Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.

The authors report in their paper that they now use a single 220mg dose of the NSAID naproxen with their patients. Naproxen is available over the counter (as a generic or under brand names such as Aleve) but you should check with your doctor about whether you should take it and make sure to read the as some patients with certain medical conditions shouldn’t take it.

While you might think that a single pill of naproxen can’t be very strong, other research actually supports its use for acute pain. In 15 randomized studies involving 1509 participants, naproxen was found to be effective for relieving moderate to severe pain in patients after surgery. Half of patients who were given a single dose of naproxen experienced at least half pain relief and the effects of the medicine lasted on average for up to nine hours.

You can read more about naproxen for postoperative pain at the, REFERENCE: Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. “A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial.

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What are the most common ERCP complications?

Symptoms of Pancreatitis after ERCP – Pancreatitis after ERCP is one of the most common ERCP complications. In most cases, pancreatitis after ERCP resolves on its own without intensive medical treatment. However, pancreatitis can be life-threatening in severe cases.

What are the symptoms of pancreatitis after ERCP?

Infection Symptoms – Infection after ERCP may also develop. Main types of infection after ERCP include cholangitis and cholecystitis. Cholangitis is the infection of the common bile duct, which transmits the body’s bile to the intestines and gallbladder from where bile is created in the liver.

Does rofecoxib cause severe pain after stent removal?

Severe pain after stent removal: How often does it happen and can anything prevent it? How Much Pain Is Common After Ercp With Stent Can a single pill prevent post stent removal pain? (Image from Office.com) Many patients complain of some pain after having a ureteral stent is removed. This pain is usually mild and self-limited. However, the pain can sometimes be severe. Because patients may not have been warned about the possibility of significant pain beforehand, it can come as an unwelcome surprise, and patients may be left wondering whether something is wrong.

  1. Patients who are affected by this pain may describe it as being worse than their original stone pain.
  2. In some cases the pain can be bad enough to bring them back to the emergency room.
  3. Up to now, there hasn’t been much research on this topic and it was not clear how often this phenomenon occurs or what might be done to prevent it.

A recent publication in the journal BJU International now suggests that severe pain after stent removal may occur in as many as half (55%) of patients. In the study, performed by researchers at Oregon Health & Science University and the Portland Veterans Administration Medical Center, patients having their indwelling ureteral stents removed were either given a placebo pill or a single 50mg dose of the non-steroidal anti-inflammatory drug (NSAID) rofecoxib fifteen minutes before their stent removal procedure.

Patients were asked to report their pain just before and 24 hours after their stent removal on a scale ranging from 1 to 10, with 7 or above being considered severe pain. Six of the eleven patients (55%) given placebo developed severe pain after their stent removal while none of the ten patients given rofecoxib developed severe pain.

The authors speculated that the mechanism by which the NSAID medicine may have provided such a dramatic reduction in severe pain occurrence might have been through reducing ureteral spasms or by decreasing pressure within the kidney. While the results of the study are very encouraging, further research will be needed to confirm the findings.

For now though, the study is currently the only evidence we have on how often post stent removal severe pain occurs and what we might do to prevent it – take a single dose of a NSAID pain medication fifteen minutes before removing a stent. Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.

The authors report in their paper that they now use a single 220mg dose of the NSAID naproxen with their patients. Naproxen is available over the counter (as a generic or under brand names such as Aleve) but you should check with your doctor about whether you should take it and make sure to read the as some patients with certain medical conditions shouldn’t take it.

While you might think that a single pill of naproxen can’t be very strong, other research actually supports its use for acute pain. In 15 randomized studies involving 1509 participants, naproxen was found to be effective for relieving moderate to severe pain in patients after surgery. Half of patients who were given a single dose of naproxen experienced at least half pain relief and the effects of the medicine lasted on average for up to nine hours.

You can read more about naproxen for postoperative pain at the, REFERENCE: Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. “A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial.

How long can you Live after heart stents?

Discussion – We have described the long term clinical outcome of a heterogeneous patient population undergoing stent implantation in an everyday evolving practice at our centre and according to the prevailing clinical practice between 1986 and 1996. This study cannot be compared to clinical trials, which include only selected patients and only contemporary techniques. The major chronological milestones in evolving stent practice during this decade of coronary stenting were: use of post dilatation to improve acute results of Wallstent implantation (1987); introduction of balloon expandable Palmaz-Schatz stents (1991); appearance of loose crimpable Palmaz-Schatz stents; gradual replacement of anticoagulation by ticlopidine and use of high pressure post dilatation with “oversized” balloons (1994); and appearance of multiplicity of stent designs (1995). The principal observation which can be made on the basis of our findings is that five year survival after stent implantation in unselected “all comers”, including the earliest experiences, is an impressive 86%, which can be expected to be even higher in the post ticlopidine and stent optimisation era. Striking differences in the occurrence of myocardial infarction and need for CABG or repeat PTCA were found between the patient groups treated with anticoagulants and ticlopidine, both in-hospital and late outcome. However, because of the simultaneous evolution in stent implant techniques with use of oversized balloons to high pressure (> 14 atm), this apparent benefit of ticlopidine treatment cannot be simply attributed to ticlopidine itself. The decrease in bleeding complications can, however, be attributed to the cessation of systematic anticoagulation.

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Is bleeding normal with ureter stent?

Can I work with a ureteral stent? – Yes, you can continue your normal activities with a stent in place. Though there may be some physical discomfort, a stent will not physically limit you. Lifting, or reaching your hands above your head repeatedly may cause bleeding, or worsening bleeding that may already be present. This is related to increased irritation of the stent on your bladder.

When should a biliary stent be removed?

Function Of Biliary Stent: Complications After Stent Removal Biliary stent is a metal or plastic tube that is introduced in the bile duct to maintain the patency of blocked duct. With advent of stents it has become easy to treat any type of obstruction in the bile duct.

Gallstones, tumors, and strictures (narrowing), all can obstruct easy flow of bile. Stents helps to widen the bile duct so that bile can flow smoothly into the intestine. Bile is fluid manufactured by liver which helps to digest fat in the food. Gallbladder is a storehouse for bile. It is a small bag under the liver.

Bile flows to intestine through the bile duct. When the duct is obstructed, bile gets accumulated leading to various symptoms such as jaundice, itching, lack of appetite etc. Insertion of biliary stent in a blocked bile duct helps to alleviate the symptoms and improve the function of liver.

Does removal of ureteral stent hurt?

Discussion – Although studies have previously called into question the necessity of ureteral stenting after uncomplicated lithotripsy, 8, 12 postoperative stent placement remains common and the question of whether to stent remains unresolved.13 The results of this survey identify the morbidity that can be associated with stent removal and provides insight into the experiences and preferences of urologic patients who undergo these procedures. The majority of patients reported moderate-to-severe levels of pain with stent removal, with an overall mean pain of 4.8 on a scale of 1 to 10. Office cystoscopy resulted in the highest mean pain, followed by use of a dangler-string in the office. Although the presumption is that stent removal by string in the office is more benign than cystoscopy, our data do not support this notion, with both methods reporting similar pain levels. Methods that reported lowest mean pain were self-removal via dangler-string at home and OR cystoscopy. Across all the methods, there was also a significant proportion of respondents (43%) who reported minimal or no pain. Few prior studies have examined pain during stent removal. The studies that have been done have found no significant differences in pain between patients who had their stents removed by cystoscopy or extraction string. Kuehhas and colleagues reported that in their patients, pain during rigid cystoscopic stent removal was similar to that for office stent string removal.14 They did not evaluate self-removal or OR removal of stents. Barnes and colleagues reported similar findings in their study.15 In their prospective, randomized study, they found no difference in visual analog pain scores between patients who had stents removed by cystoscopy and those who had theirs removed by stent string. In addition to examining pain, we assessed patient preferences. Removal of the stent by office-cystoscopy was the least-preferred method. Conversely, having patients pull out their own stent and operating room cystoscopy, with the patient receiving some form of anesthesia, had the highest proportion of patients reporting that they would be willing to undergo the same procedure. We recognize that the choice of a specific method can be influenced by multiple factors, including cost, resources, and the risk of accidental dislodgement when a string is left in place.12 Delayed pain after stent removal appears to be underappreciated by physicians. As a result, patients often report that they were not adequately counseled about this potential morbidity. We found that delayed pain occurring after removal of a ureteral stent was an important source of patient morbidity, with a third of patients surveyed reporting delayed severe pain after stent removal, including the 8% who reported having to return to an emergency department. Removal by stent-string was significantly more likely to result in a return trip. No studies have examined this difference but there is a possibility that the string itself may contribute to physiologic changes that lead to delayed pain after stent removal, such as trigonal edema. More studies are needed to examine this difference. Investigators have started to examine how to prevent delayed pain in all patients who have stents removed. Tadros and colleagues previously examined poststent removal pain and found that NSAIDs may help in its prevention.16 In their randomized, double-blind controlled trial, they found a significant reduction in poststent removal pain with the administration of a COX-2 inhibitor prior to cystoscopy to remove the stent. Fifty-five percent of participants who were given the placebo experienced severe pain, while in the medicated group, no patients reported severe pain ( p <0.01). Though the study used a small sample size, it establishes the foundation for larger studies to examine the utility of preventative measures. Interestingly, we found that there were significant differences in pain between self-string and doctor-string removal. We suspect that increased anxiety or a heightened anticipation of pain in the presence of a practitioner may contribute to these differences. A similar phenomenon has been reported in patients who undergo prostate biopsy.17 Patients who had increased preprocedure anxiety experienced greater intraprocedural pain, due to a heightened adrenergic response causing hyperalgesia and hypersensitization of pain receptors.18, 19 Conversely, in patients who remove their stents at home, the ability to remove the stents themselves may have a calming effect. However, these patients also reported the highest frequency of delayed episodes of severe pain, potentially due to less certainty about recurrent pain. Selection bias may also have a role in the difference observed with patients who have greater baseline anxiety electing to have their stents removed in the urologist office. Better counseling patients about what to expect after their stent self-removal and recommending premedication with an NSAID may help to allay this anxiety and prevent the pain. We found variations in the method of stent removal by region. Patients were more likely to undergo office cystoscopy in the United States while in Canada removal by string was the preferred technique. In Austria, Kuehhas and colleagues reported that, in their experience of removing stents via rigid cystoscopy without anesthesia, the mean pain experienced was relatively low.14 In spite of these results, they have started to remove stents via string, signaling a potential paradigm shift toward the self-string method. Similar calls have been made in the United Kingdom.3 This study has several strengths, including a large sample size and by virtue of its website-based recruitment, a more diverse population geographically and in practice settings than would typically be available in an academic cohort of patients. This may make the results more reflective of the experiences of urology patients overall. There were also limitations. In this anonymous survey, we did not collect demographic data and therefore cannot assess whether stent-removal experiences differ by gender, age, and race. We also do not have data available on the length of time stents were in place or the reasons why stents were placed. We were not able to determine whether rigid or flexible cystoscopy was used during cystoscopic removal of stents or whether any adjunctive medications or local anesthesia was used. It is possible that reporting errors may exist for the method of stent removal. Respondents may not have understood the difference between an OR and a clinic procedure room or there may be variations in the use of these terms by region. These results may also have been influenced by response bias. Website visitors and respondents to the survey may not be representative of all patients who undergo stent removal. However, respondents to the survey aligned remarkably well with other existing research on stent removal that polled urologists instead, suggesting that the respondents are indeed representative. Auge and colleagues reported that U.S. urologists utilized office-cysto (42%), doctor-string (37%), and self-string (9%) 5 while methods reported in this survey were office-cysto (44%), doctor-string (27%), OR-stent (17%), and self-string (12%). Despite these limitations, this study provides novel information on the morbidity of stent removal and the related preferences of patients. Most importantly, it identifies a need to address pain after the ureteral stent is removed in a significant portion of patients. This information can help guide patient counseling regarding stent removal and future studies.

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