title: Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video).
abstract: BACKGROUND
  Benign biliary strictures (BBS) are usually managed with plastic stents, whereas placement of uncovered metallic stents has been associated with failure related to mucosal hyperplasia.
  
  
  OBJECTIVE
  We analyzed the efficacy and safety of temporary placement of a covered self-expanding metal stent (CSEMS) in BBS.
  
  
  METHODS
  Patients with BBS received temporary placement of CSEMSs until adequate drainage was achieved; confirmed by resolution of symptoms, normalization of liver function tests, and imaging.
  
  
  METHODS
  Tertiary-care center with long-standing experience with CSEMSs.
  
  
  METHODS
  Seventy-nine patients with BBS secondary to chronic pancreatitis (32), calculi (24), liver transplant (16), postoperative biliary repair (3), autoimmune pancreatitis (3), and primary sclerosing cholangitis (1).
  
  
  METHODS
  ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or a rat-tooth forceps.
  
  
  METHODS
  End points were efficacy, morbidity, and clinical response.
  
  
  RESULTS
  CSEMSs were removed from 65 patients. Resolution of the BBS was confirmed in 59 of 65 patients (90%) after a median follow-up of 12 months after removal (range 3-26 months). If patients who were lost to follow-up, developed cancer, or expired were considered failures, then an intent-to-treat global success rate of 59 of 79 (75%) was obtained. Complications associated with placement included 3 post-ERCP pancreatitis (4%), 1 postsphincterotomy bleed (1%), and 2 pain that required CSEMS removal (2%). In 11 patients (14%), the CSEMS migrated. In 1 patient, CSEMS removal was complicated by a bile leak that was successfully managed with plastic stents.
  
  
  CONCLUSIONS
  Pilot study from a single center.
  
  
  CONCLUSIONS
  Temporary CSEMS placement in patients with BBS offers a potential alternative to surgery.
authors.affiliation: Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Brian
authors.initials: B
authors.lastname: Behm
authors.forename: Bridger W
authors.initials: BW
authors.lastname: Clarke
authors.forename: Andrew
authors.initials: A
authors.lastname: Brock
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Sarah A
authors.initials: SA
authors.lastname: De La Rue
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010865:Pilot Projects; D019919:Prosthesis Implantation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals