Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video).
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.
Kahaleh
Michel
M
Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
Behm
Brian
B
Clarke
Bridger W
BW
Brock
Andrew
A
Shami
Vanessa M
VM
De La Rue
Sarah A
SA
Sundaram
Vinay
V
Tokar
Jeffrey
J
Adams
Reid B
RB
Yeaton
Paul
P
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
D020099:Coated Materials, Biocompatible; D008670:Metals