title: Fully covered self-expanding metal stents in the management of difficult common bile duct stones.
abstract: OBJECTIVE
  plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction.
  
  
  METHODS
  after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage.
  
  
  RESULTS
  a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken.
  
  
  CONCLUSIONS
  in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.
authors.forename: Jesús
authors.initials: J
authors.lastname: García-Cano
authors.forename: Amanda Karolina
authors.initials: AK
authors.lastname: Reyes-Guevara
authors.forename: Teresa
authors.initials: T
authors.lastname: Martínez-Pérez
authors.forename: Laura
authors.initials: L
authors.lastname: Valiente-González
authors.forename: Raquel
authors.initials: R
authors.lastname: Martínez-Fernández
authors.forename: Miriam
authors.initials: M
authors.lastname: Viñuelas-Chicano
authors.forename: Carmen Julia
authors.initials: CJ
authors.lastname: Gómez-Ruiz
authors.forename: Julia
authors.initials: J
authors.lastname: Morillas-Ariño
authors.forename: Gracia
authors.initials: G
authors.lastname: Pérez-Vigara
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Pérez-García
authors.forename: Ángel
authors.initials: Á
authors.lastname: Pérez-Sola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents
chemical_list: D008670:Metals