title: Management of benign biliary strictures with a novel retrievable self-expandable metal stent.
abstract: OBJECTIVE
  Endoscopic placement of covered self-expandable metal stent (SEMS) has gained popularity in the management of benign biliary strictures (BBS). The existing SEMS has been designed primarily to palliate malignant biliary obstruction and has a high frequency of stent migration, difficulty in retrieval and stricture recurrence after stent removal. This study aimed to design a novel retrievable SEMS dedicated to the treatment of extrahepatic BBS and evaluate its clinical efficacy and safety.
  
  
  METHODS
  A short fully covered SEMS (FCSEMS) with a retrieval lasso was designed for the specific treatment of BBS. A total of 45 patients with segmental extrahepatic BBS were included in this study. The stent was placed entirely inside the bile duct with only the retrieval lasso extending from the papilla. The stents were recommended to be in situ for 6 to 12 months before removal.
  
  
  RESULTS
  The FCSEMS was successfully placed in all 45 patients. In all, 33 patients had their FCSEMS successfully removed after a mean period of 8.6 ± 3.7 (range 2-15.5) months. Stent migration occurred in 9.1% of the patients. During a mean follow-up of 18.9 months after stent removal, recurrent stricture was found in 2 (6.1%) patients and was successfully treated with a second FCSEMS. Overall, the strictures resolved in 30/33 (90.9%) patients.
  
  
  CONCLUSIONS
  Intraductal placement of a short FCSEMS is suitable for the treatment of segmental extrahepatic BBS. This new removable design offered prolonged stenting and drainage for BBS for up to one year with minimal complications.
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Bing
authors: B
authors: Hu
authors: Joseph W
authors: JW
authors: Leung
authors: Dao Jian
authors: DJ
authors: Gao
authors: Tian Tian
authors: TT
authors: Wang
authors: Jun
authors: J
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020878:Device Removal / Q000379:methods; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents / Q000009:adverse effects
keywords: ERCP; benign biliary stricture; biliary injury; liver transplantation; self-expandable metal stent (SEMS)