title: Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: time to revisit our therapeutic options?
abstract: BACKGROUND
  Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS.
  
  
  OBJECTIVE
  : To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS.
  
  
  METHODS
  Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications.
  
  
  RESULTS
  A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as follows: postsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)].
  
  
  CONCLUSIONS
  FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.
authors: Weill Cornell Medical Center, New York, NY, USA. mkahaleh@gmail.com
authors: Michel
authors: M
authors: Kahaleh
authors: Alan
authors: A
authors: Brijbassie
authors: Amrita
authors: A
authors: Sethi
authors: Marisa
authors: M
authors: Degaetani
authors: John M
authors: JM
authors: Poneros
authors: David E
authors: DE
authors: Loren
authors: Thomas E
authors: TE
authors: Kowalski
authors: Divyesh V
authors: DV
authors: Sejpal
authors: Sandeep
authors: S
authors: Patel
authors: Laura
authors: L
authors: Rosenkranz
authors: Kevin N
authors: KN
authors: McNamara
authors: Isaac
authors: I
authors: Raijman
authors: Jayant P
authors: JP
authors: Talreja
authors: Monica
authors: M
authors: Gaidhane
authors: Bryan G
authors: BG
authors: Sauer
authors: Peter D
authors: PD
authors: Stevens
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000473:pathology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome