title: Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video).
abstract: BACKGROUND
  Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available.
  
  
  OBJECTIVE
  Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS.
  
  
  METHODS
  CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging.
  
  
  METHODS
  Tertiary care center with long-standing experience with metal stents.
  
  
  METHODS
  A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1).
  
  
  METHODS
  ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth.
  
  
  METHODS
  Stricture resolution and morbidity.
  
  
  RESULTS
  The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal.
  
  
  CONCLUSIONS
  Pilot study from a single center.
  
  
  CONCLUSIONS
  Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.
authors.affiliation: Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
authors.forename: Anshu
authors.initials: A
authors.lastname: Mahajan
authors.forename: Henry
authors.initials: H
authors.lastname: Ho
authors.forename: Bryan
authors.initials: B
authors.lastname: Sauer
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Phillips
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Kristi
authors.initials: K
authors.lastname: Ellen
authors.forename: Michele
authors.initials: M
authors.lastname: Rehan
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Schmitt
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D002779:Cholestasis / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014741:Video Recording