Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis.
OBJECTIVE
Benign biliary strictures (BBS) may occur in patients with chronic pancreatitis and may lead to secondary biliary cirrhosis or recurrent cholangitis. Although surgical diversion may provide definitive therapy, it can be associated with significant morbidity. Endoscopic therapy with plastic stents has been used as an alternative to surgery but has resulted in unsatisfactory long-term outcomes. We evaluated the temporary placement of partially covered self-expandable metallic stents (PCMS) in patients with BBS due to chronic pancreatitis.


METHODS
A total of 20 patients with BBS due to chronic pancreatitis underwent temporary placement of PCMS over a 6-year period. The primary outcome of interest was the proportion of patients with stricture resolution persisting 6 months after stent removal. Secondary outcomes included the stent failure rate, number of endoscopic sessions required to achieve biliary drainage, total duration of stenting, and complication rate.


RESULTS
Adequate biliary drainage was achieved in 19 patients with PCMS (95%). Eighteen of the 20 patients (90%) had persistent stricture resolution 6 months after PCMS removal. In two of the 20 patients (10%), PCMS stenting failed and these patients underwent alternative therapies. Complications occurred in four patients (20%). Median duration of PCMS placement was 5 months, requiring a median of two endoscopic procedures.


CONCLUSIONS
In this series of patients with BBS due to chronic pancreatitis, temporary PCMS placement achieved persistent stricture resolution in the majority of patients with acceptable complication rates. Comparative trials evaluating temporary PCMS placement and plastic stenting in patients with BBS due to chronic pancreatitis are needed.
Behm
B
B
Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
Brock
A
A
Clarke
B W
BW
Ellen
K
K
Northup
P G
PG
Dumonceau
J M
JM
Kahaleh
M
M
D000328:Adult; D001659:Biliary Tract; D001660:Biliary Tract Diseases / Q000209:etiology*; D002779:Cholestasis / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible