Journal Article

Management of Complications Associated with Partially Covered Biliary Metal Stents

Jain, Animesh, Rehan, Michele E, Ellen, Kristi, Ho, Henry, Gosain, Sonia, Kahaleh, Michel, Brock, Andrew, Shami, Vanessa M, Mahajan, Anshu

2010

Overview

Background Partially covered metal stents (PCMS) have been increasingly used for both malignant and benign biliary indications. This study reports their complications and subsequent management. Methods Over 5 years, all patients receiving biliary PCMS were followed prospectively until stent-related dysfunction or death. Data were analyzed for the following variables: primary disease, time until revision, and type and reason for revision. Results PCMS were placed in 396 patients (247 with malignant biliary strictures and 149 with benign biliary disease). Complications were observed in 70 patients (18%), occurring a mean time following placement of 159 days. Duodenal migration occurred in 27 cases (6.8%), while proximal migration occurred in 9 cases (2.3%). Cholecystitis was documented in 13 cases (3.3%). There were six cases of stent occlusion due to debris or sludge (1.6%), four cases of pancreatitis (1%), four cases of tumor overgrowth (1%), three cases of benign stenosis in the uncovered portion of the PCMS (0.8%), two cases of abdominal pain (0.5%), one case of an infected biloma (0.3%), and one case of a liver abscess (0.3%). Conclusions Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications.

• Publisher: Boston : Springer US,Springer US,Springer,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Biochemistry / Biological and medical sciences / Cholangiopancreatography, Endoscopic Retrograde - methods / Cholecystectomy - methods / Cholecystitis / Cholecystitis - diagnosis / Cholecystitis - etiology / Cholecystitis - surgery / Cholestasis - diagnosis / Cholestasis - surgery / Coated Materials, Biocompatible / Complications and side effects / Digestive system / Drainage - methods / Feeding. Feeding behavior / Female / Follow-Up Studies / Foreign-Body Migration - diagnosis / Foreign-Body Migration - etiology / Foreign-Body Migration - surgery / Fundamental and applied biological sciences. Psychology / Gastroenterology / Hepatology / Humans / Investigative techniques, diagnostic techniques (general aspects) / Liver diseases / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Mortality / Oncology / Original Article / Pancreatitis / Postoperative Complications / Prospective Studies / Prosthesis Failure / Radiodiagnosis. Nmr imagery. Nmr spectrometry / Reoperation - methods / Stent (Surgery) / Stents - adverse effects / Transplant Surgery / Treatment Outcome / Vertebrates: anatomy and physiology, studies on body, several organs or systems / Young Adult