Temporary placement of covered self-expandable metallic stents in patients with biliary leak: midterm evaluation of a pilot study.
BACKGROUND
Management of biliary leaks includes ERCP and stent placement. The ability to temporarily place a partially covered self-expandable metallic stent (CSEMS) might offer an advantage in the treatment of biliary leaks.


OBJECTIVE
We analyzed our 2 years' experience when using this innovative technique.


METHODS
Patients in whom a previous ERCP had failed to resolve a bile leak or patients with severe comorbidities were offered CSEMS and were followed prospectively for clinical and radiologic responses.


METHODS
Tertiary-care center with long-standing experience of using CSEMS.


METHODS
A total of 16 patients were included. Of these, 7 had previously undergone unsuccessful plastic stent placement, 3 had previously failed ERCP, and 7 had severe comorbidities that prevented multiple interventions.


METHODS
ERCP with placement of a CSEMS covering the cystic duct take-off in the case of a cystic-stump leak. CSEMS were removed after resolution of the leak.


METHODS
Efficacy and safety of the CSEMS in bile leaks; complications were also evaluated.


RESULTS
Of the patients studied, 15 responded to CSEMS placement with complete resolution of the leak on imaging. One patient with partial cholecystectomy relapsed and underwent drainage; another patient responded to the treatment but required revision because of migration. CSEMS were left in place for a median time of 3 months (range, 1-17 months). Complications included 1 proximal and 1 distal migration.


CONCLUSIONS
Pilot study from a single center.


CONCLUSIONS
CSEMS is an excellent option in this subgroup of patients not responding to plastic stent placement or with severe comorbidities.
Kahaleh
Michel
M
Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
Sundaram
Vinay
V
Condron
Steven L
SL
De La Rue
Sarah A
SA
Hall
Joshua D
JD
Tokar
Jeffrey
J
Friel
Charles M
CM
Foley
Eugene F
EF
Adams
Reid B
RB
Yeaton
Paul
P
D000328:Adult; D000368:Aged; D001646:Bile; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002763:Cholecystectomy / Q000009:adverse effects*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome