Journal Article

A US Multicenter Study of Safety and Efficacy of Fully Covered Self-Expandable Metallic Stents in Benign Extrahepatic Biliary Strictures

Lennon, Anne Marie, Singh, Vikesh, Saxena, Payal, Diehl, David L., Nasr, John, Kapoor, Sumit, Shin, Eun Ji, Kalloo, Anthony N., Shieh, Frederick, Komanduri, Srinadh, Khashab, Mouen A., Kumbhari, Vivek, Sze, Wilson, Buscaglia, Jonathan M.

2015

Overview

Background Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges. Aims The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS. Methods A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded. Results A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57 % were males. Stricture resolution occurred in 81 % of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7 %) was the most common complication, followed by stent occlusion (4.9 %), cholangitis (4.1 %), and pancreatitis (3.3 %). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis. Conclusions Majority of BBS can be successfully managed with 1–2 consecutive FCSEMS with stent dwell time of 6 months.

• Publisher: Springer US,Springer,Springer Nature B.V
• Subject: Aged / Bile Ducts, Extrahepatic / Biochemistry / Cholangiopancreatography, Endoscopic Retrograde - adverse effects / Cholangiopancreatography, Endoscopic Retrograde - instrumentation / Cholangiopancreatography, Endoscopic Retrograde - mortality / Cholangitis - etiology / Cholangitis - mortality / Cholestasis - diagnosis / Cholestasis - mortality / Cholestasis - therapy / Complications and side effects / Device Removal / Drainage - adverse effects / Drainage - instrumentation / Drainage - mortality / Female / Foreign-Body Migration - etiology / Gastroenterology / Hepatology / Humans / Male / Medicine / Medicine & Public Health / Metals / Middle Aged / Oncology / Original Article / Pancreatitis / Pneumoviridae / Prosthesis Design / Prosthesis Failure / Recurrence / Retrospective Studies / Risk Factors / Stent (Surgery) / Stents / Tertiary Care Centers / Time Factors / Transplant Surgery / Treatment Outcome / United States