Temporary Placement of Covered Self-Expandable Metal Stents in Benign Biliary Strictures: A New Paradigm? (With Video)

Gastrointest Endosc. 2008 Mar;67(3):446-54. doi: 10.1016/j.gie.2007.06.057.

Abstract

Background: Benign biliary strictures (BBS) are usually managed with plastic stents, whereas placement of uncovered metallic stents has been associated with failure related to mucosal hyperplasia.

Objective: We analyzed the efficacy and safety of temporary placement of a covered self-expanding metal stent (CSEMS) in BBS.

Design: Patients with BBS received temporary placement of CSEMSs until adequate drainage was achieved; confirmed by resolution of symptoms, normalization of liver function tests, and imaging.

Setting: Tertiary-care center with long-standing experience with CSEMSs.

Patients: Seventy-nine patients with BBS secondary to chronic pancreatitis (32), calculi (24), liver transplant (16), postoperative biliary repair (3), autoimmune pancreatitis (3), and primary sclerosing cholangitis (1).

Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or a rat-tooth forceps.

Main outcome measurements: End points were efficacy, morbidity, and clinical response.

Results: CSEMSs were removed from 65 patients. Resolution of the BBS was confirmed in 59 of 65 patients (90%) after a median follow-up of 12 months after removal (range 3-26 months). If patients who were lost to follow-up, developed cancer, or expired were considered failures, then an intent-to-treat global success rate of 59 of 79 (75%) was obtained. Complications associated with placement included 3 post-ERCP pancreatitis (4%), 1 postsphincterotomy bleed (1%), and 2 pain that required CSEMS removal (2%). In 11 patients (14%), the CSEMS migrated. In 1 patient, CSEMS removal was complicated by a bile leak that was successfully managed with plastic stents.

Limitation: Pilot study from a single center.

Conclusions: Temporary CSEMS placement in patients with BBS offers a potential alternative to surgery.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Coated Materials, Biocompatible*
  • Cohort Studies
  • Device Removal
  • Equipment Design
  • Female
  • Humans
  • Male
  • Metals*
  • Middle Aged
  • Pilot Projects
  • Prosthesis Implantation*
  • Stents*
  • Time Factors
  • Treatment Outcome

Substances

  • Coated Materials, Biocompatible
  • Metals