title: The use of double lasso, fully covered self-expandable metal stents with new "anchoring flap" system in the treatment of benign biliary diseases.
abstract: BACKGROUND
  Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable metal stents (FCSEMS) but stent migration occurs in up to 35.7 %. The aim of this study was to prospectively assess the rate of, safety and effectiveness and stent migration of a new biliary FCSEMS with an anti-migration flap (FCSEMS-AF) in patients with BBD.
  
  
  METHODS
  This was a prospective study from four Italian referral endoscopy centers of 32 consecutive patients (10 females and 22 males; mean age: 60.1 ± 14.8 years; range: 32-84 years) with BBD who were offered endoscopic placement of a FCSEMS-AF as first-line therapy.
  
  
  RESULTS
  Were 24 strictures and 8 leaks. Stent placement was technically successful in 32/32 patients (100 %). Immediate clinical improvement was seen in all 32 patients (100 %). One late stent migration occurred (3.3 %). FCSEMS-AF were removed from 30 of the 32 patients (93.7 %) at a mean (± SD) of 124.4 ± 84.2 days (range: 10-386 days) after placement. All patients remained clinically and biochemically well at 1- and 3-month follow-up. One patient (3.3 %) with a post-laparoscopic cholecystectomy stricture developed distal stent migration at 125 days.
  
  
  CONCLUSIONS
  This new FCSEMS with anti-migration flap seems to be a safe and effective first-line treatment option for patients with BBD.
authors.affiliation: Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo, Universitary Hospital, University of Milan, Via A. di Rudinì no. 8, 20142, Milan, Italy, b_mangiavillano@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Mangiavillano
authors.forename: G
authors.initials: G
authors.lastname: Manes
authors.forename: T H
authors.initials: TH
authors.lastname: Baron
authors.forename: R
authors.initials: R
authors.lastname: Frego
authors.forename: M
authors.initials: M
authors.lastname: Dinelli
authors.forename: F
authors.initials: F
authors.lastname: Radaelli
authors.forename: V
authors.initials: V
authors.lastname: Teruzzi
authors.forename: A
authors.initials: A
authors.lastname: Amato
authors.forename: S
authors.initials: S
authors.lastname: Pallotta
authors.forename: T
authors.initials: T
authors.lastname: Santoro
authors.forename: E
authors.initials: E
authors.lastname: Masci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy*; D001649:Bile Duct Diseases / Q000209:etiology / Q000628:therapy*; D001652:Bile Ducts / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications; D002763:Cholecystectomy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Gastrointest Endosc. 2002 May;55(6):680-6
references.pmid: 11979250
references.citation: J Dig Dis. 2012 Sep;13(9):486-90
references.pmid: 22908975
references.citation: J Clin Gastroenterol. 2013 Sep;47(8):695-9
references.pmid: 23442836
references.citation: Endoscopy. 2011 Jun;43(6):512-7
references.pmid: 21618151
references.citation: Gastrointest Endosc. 2009 Aug;70(2):303-9
references.pmid: 19523620
references.citation: World J Gastroenterol. 2010 Jul 28;16(28):3597-600
references.pmid: 20653071
references.citation: Dig Liver Dis. 2013 May;45(5):430-2
references.pmid: 23280159
references.citation: Endoscopy. 2012 Oct;44(10):923-7
references.pmid: 22893134
references.citation: Br J Surg. 1996 Jun;83(6):764-8
references.pmid: 8696734
references.citation: Gastrointest Endosc. 2012 Apr;75(4):783-9
references.pmid: 22325806
references.citation: Liver Transpl. 2009 Nov;15(11):1493-8
references.pmid: 19877248
references.citation: Gastrointest Endosc. 2008 Mar;67(3):446-54
references.pmid: 18294506
references.citation: J Clin Gastroenterol. 2004 Feb;38(2):118-23
references.pmid: 14745285
references.citation: Gastrointest Endosc. 2007 Jul;66(1):52-9
references.pmid: 17324415
references.citation: Gastrointest Endosc. 2011 Jan;73(1):64-70
references.pmid: 21184871
references.citation: Gastrointest Endosc. 2012 Jul;76(1):196-201
references.pmid: 22726483
references.citation: Gut. 1996 Jan;38(1):141-7
references.pmid: 8566842
references.citation: Gastrointest Endosc. 2004 Dec;60(6):945-52
references.pmid: 15605010
references.citation: Gastrointest Endosc. 2001 Aug;54(2):162-8
references.pmid: 11474384
references.citation: Gastrointest Endosc. 2010 Mar;71(3):446-54
references.pmid: 20189503
references.citation: Gastrointest Endosc. 2012 May;75(5):1080-5
references.pmid: 22401821
references.citation: Endoscopy. 2012 Mar;44(3):277-98
references.pmid: 22297801
references.citation: Clin Gastroenterol Hepatol. 2006 Mar;4(3):381-6
references.pmid: 16527703
references.citation: Gastrointest Endosc. 1992 Jan-Feb;38(1):12-8
references.pmid: 1612372
references.citation: Endoscopy. 2009 Sep;41(9):781-6
references.pmid: 19693751
references.citation: Gastrointest Endosc. 2005 Nov;62(5):742-8
references.pmid: 16246690