title: Anchoring flap versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos).
abstract: BACKGROUND
  Recently, placement of fully covered self-expandable metal stents (FCSEMSs) has been proposed as an alternative treatment for the management of benign biliary strictures. However, the major limitations of FCSEMSs are frequent migration and removal complications.
  
  
  OBJECTIVE
  We conducted this study to compare the antimigration effects, complication rates, and short-term efficacy of 2 FCSEMSs with either an anchoring flap (AF) or a flared end (FE) at the proximal end of the stent.
  
  
  METHODS
  A multicenter, prospective comparative pilot study.
  
  
  METHODS
  Two tertiary referral centers.
  
  
  METHODS
  A total of 43 patients with benign biliary stricture who were candidates for placement of FCSEMSs were assigned to the AF (n = 22) or the FE group (n = 21).
  
  
  METHODS
  Predefined duration of placement and removal of FCSEMSs.
  
  
  RESULTS
  After a median period of placement of 6 months (interquartile range 4-6), no patients in the AF group and 33% of patients (7 of 21, 1 in proximal and 6 in distal) in the FE group had stent migration (P = .004). The removal rate of the FCSEMSs was 100% in both groups (per protocol, n = 22 in the AF group and n = 17 in the FE group). Immediate improvement of biliary stricture was 91% (20/22, per protocol) in the AF group and 88% (15/17, per protocol) in the FE group. All stents were removed without difficulty.
  
  
  CONCLUSIONS
  Short-term follow-up after the removal of FCSEMSs.
  
  
  CONCLUSIONS
  With regard to the antimigration effect of FCSEMSs for benign biliary stricture, the AF design may be superior to the FE. For up to 6 months, both FCSEMSs can be endoscopically removed without complications. (
  
  
  BACKGROUND
  NCT00945516.).
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. dhpark@amc.seoul.kr
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Choong Heon
authors.initials: CH
authors.lastname: Ryu
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Kim
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D010865:Pilot Projects; D011475:Prosthesis Failure; D018709:Statistics, Nonparametric; D015607:Stents