title: Management of an occluded biliary metallic stent.
abstract: In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.
authors.affiliation: Wiriyaporn Ridtitid, Rungsun Rerknimitr, Director of Endoscopy Unit, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr