title: Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos).
abstract: BACKGROUND
  Complex biliary stones often require temporary stent placement before a repeat attempt at extraction. To date, covered self-expandable metal stents (CSEMSs) have not been formally investigated for this indication.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Large quaternary-care center.
  
  
  METHODS
  Thirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy.
  
  
  METHODS
  Patients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction.
  
  
  METHODS
  Success achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed.
  
  
  RESULTS
  CSEMS placement was successful in establishing immediate biliary drainage in all 36 patients. Complete duct clearance at repeat ERC was achieved in 29 of 35 patients after a mean duration of 6.4 weeks. Four of the remaining 6 patients underwent sequential CSEMS placement, with eventual duct clearance after multiple ERCPs. There were no complications related to biliary obstruction. One patient died of a nonbiliary cause. Of the total 42 CSEMSs placed, there were 4 cases (9.5%) of clinically insignificant stent migration.
  
  
  CONCLUSIONS
  Single-center experience, retrospective design.
  
  
  CONCLUSIONS
  CSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York 10021, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Cerefice
authors.forename: Bryan
authors.initials: B
authors.lastname: Sauer
authors.forename: Muhammad
authors.initials: M
authors.lastname: Javaid
authors.forename: LaVone A
authors.initials: LA
authors.lastname: Smith
authors.forename: Sonia
authors.initials: S
authors.lastname: Gosain
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D015607:Stents / Q000009:adverse effects
chemical_list: D020099:Coated Materials, Biocompatible