title: Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data - a case series.
abstract: Techniques for management of bile leaks include biliary sphincterotomy and stenting. Partially covered self-expandable metallic stents have been used in complex bile leaks, but they are associated with migration and hyperplasia. A fully covered self-expandable metallic stent (CSEMS) with anchoring fins might be effective in treating bile leaks without these complications. The aim of this study was to investigate the safety and efficacy of temporary placement of a CSEMS for resolving complex bile leaks. Thirteen patients with complex bile leaks underwent endoscopic retrograde cholangiopancreatography (ERCP) with temporary placement of a CSEMS following cholecystectomy (n = 8) or liver transplantation (n = 5). All patients had resolution of their bile leaks. Two patients developed a stricture below the confluence. Three patients died from unrelated causes. Two deaths occurred prior to CSEMS removal. Ten of 11 patients had evidence of biliary debris at the time of CSEMS removal. Overall, temporary placement of CSEMS is efficacious atresolving bile leaks. CSEMS are less prone to migration, but are associated with ulcerations, de novo choledocholithiasis, and strictures.
authors.affiliation: Digestive Health Center of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Wang
authors.forename: K
authors.initials: K
authors.lastname: Ellen
authors.forename: C L
authors.initials: CL
authors.lastname: Berg
authors.forename: T M
authors.initials: TM
authors.lastname: Schmitt
authors.forename: M
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011474:Prosthesis Design; D015607:Stents