title: Temporary placement of covered self-expandable metallic stents in the management of benign biliary strictures.
abstract: OBJECTIVE
  Currently, endoscopic intervention is widely attempted as the first-line treatment of benign biliary strictures because of its convenience and low morbidity. Plastic tube stents (PS) are usually used for such treatment; however, covered self-expandable metallic stents (C-SEMS) are becoming more commonly used at some institutions. The temporary placement of C-SEMS may lead to better outcomes because of their larger diameter and, therefore, better dilation of the stricture, especially in refractory cases. The aim of the present study was to evaluate the efficacy of the temporary placement of C-SEMS in the management of benign biliary strictures.
  
  
  METHODS
  We retrospectively reviewed our endoscopic retrograde cholangiopancreatography (ERCP) database (May 1996 to December 2010), and extracted the data of patients who underwent endoscopic treatment for benign biliary strictures. Then, the follow-up data from patient charts were reviewed to determine the long-term outcomes of those procedures.
  
  
  RESULTS
  All patients (n = 56) initially had a PS placed, with or without balloon dilation. However, C-SEMS placement was later attempted in 12 patients because the stricture was refractory to placement of the PS. During their follow-up periods, two patients died of unrelated diseases after 15 and 17 months, and another two still had the C-SEMS in place after 9 and 50 months. In the remaining eight patients, the C-SEMS was removed after a median placement period of 6 months (range, 2-15). Seven patients in this group have not experienced a recurrence at a median follow-up time of 48 months. However, in one patient, stenosis did recur 8 months after the C-SEMS was removed.
  
  
  CONCLUSIONS
  Temporary placement of C-SEMS can be a treatment option for benign biliary strictures, especially in refractory cases.
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan. yasudaic@aol.com
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tomita
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000628:therapy*; D001652:Bile Ducts / Q000473:pathology*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult
chemical_list: D008670:Metals