Covered self-expanding metal stents for the management of common bile duct stones.
OBJECTIVE
Little medical literature exists for the use of fully covered self-expanding metal stents (CSEMSs) in the management of retained common bile duct (CBD) stones. Our aim was to assess the safety and efficacy of CSEMSs for the indication of retained "difficult" CBD stones.


METHODS
This retrospective cases series included 44 patients (30 women; median age, 69 years [range, 24-88]) who underwent CSEMS insertion for the indication of retained "difficult" CBD stones in 2 tertiary referral centers. Patients underwent temporary placement of CSEMSs after incomplete stone clearance at ERCP. Follow-up ERCP was arranged for stent removal and subsequent attempt at duct clearance. Procedure-related adverse events were also recorded.


RESULTS
Successful biliary drainage was achieved in all cases after CSEMS placement. Forty-two stents were removed with successful duct clearance achieved in 36 cases (82%) after a median in-stent duration of 8 weeks. There were 10 cases (22.7%) of stent migration, all noted incidentally during follow-up. One patient died of nonbiliary causes before attempted removal.


CONCLUSIONS
This is the largest published retrospective case series for use of CSEMSs for management of retained CBD stone disease to date. We have shown high success rates for this indication. A well-designed, multicenter, randomized controlled trial might address the uncertainty of cost-to-benefit ratio and appropriate duration for CSEMSs to be left in situ. Specific stent modification for this indication, including wider distal flare and retrieval purse string loop, may also be useful.
Department of Gastroenterology, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Karen
K
Hartery
Department of Gastroenterology, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Chung Sen
CS
Lee
Department of Gastroenterology, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Glen A
GA
Doherty
Department of Gastroenterology, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland.
Frank E
FE
Murray
Department of Gastroenterology, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Garret
G
Cullen
Department of Gastroenterology, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland.
Stephen E
SE
Patchett
Department of Gastroenterology, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Hugh E
HE
Mulcahy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000209:etiology; D004106:Dilatation; D005260:Female; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011475:Prosthesis Failure; D019233:Retreatment; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D055815:Young Adult