Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video)
Received 10 September 2008; accepted 12 November 2008. published online 12 June 2009.
Background
Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available.
Objective
Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS.
Design
CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging.
Setting
Tertiary care center with long-standing experience with metal stents.
Patients
A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1).
Intervention
ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth.
Main Outcome Measurements
Stricture resolution and morbidity.
Results
The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal.
Limitation
Pilot study from a single center.
Conclusion
Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.
Current affiliations: Digestive Health Center (A.M., H.H., B.S., V.M.S., K.E., M.R., M.K.) and Department of Surgery (M.S.P., T.M.S.), University of Virginia Health System, Charlottesville, Virginia, USA
Reprint requests: Michel Kahaleh, MD, FASGE, Digestive Health Center Box 800708, University of Virgina Health System, Charlottesville, VA 22908-0708.
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: M. Kahaleh has received grant support from Boston Scientific, Olympus, Alveolus, Conmed, and Cook Medical. All other authors disclosed no financial relationships relevant to this publication.
Presented as a poster at Digestive Disease Week 2008, San Diego, California (Gastrointest Endosc 2008;67:AB167).
If you want to chat with an author of this article, you may contact him at mk5ke@virginia.edu.
ABSTRACT
Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video)