Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video)

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.

Abbreviations: BBS, benign biliary strictures, CP, chronic pancreatitis, CSEMS, fully covered self-expandable metal stent, IQR, interquartile range