Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video) - 23/08/11
Reprint requests: Michel Kahaleh, MD, Digestive Health Center Box 800708, University of Virginia Health System, Charlottesville, VA 22908-0708.Charlottesville, Virginia, USA
Abstract |
Background |
Benign biliary strictures (BBS) are usually managed with plastic stents, whereas placement of uncovered metallic stents has been associated with failure related to mucosal hyperplasia.
Objective |
We analyzed the efficacy and safety of temporary placement of a covered self-expanding metal stent (CSEMS) in BBS.
Design |
Patients with BBS received temporary placement of CSEMSs until adequate drainage was achieved; confirmed by resolution of symptoms, normalization of liver function tests, and imaging.
Setting |
Tertiary-care center with long-standing experience with CSEMSs.
Patients |
Seventy-nine patients with BBS secondary to chronic pancreatitis (32), calculi (24), liver transplant (16), postoperative biliary repair (3), autoimmune pancreatitis (3), and primary sclerosing cholangitis (1).
Intervention |
ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or a rat-tooth forceps.
Main Outcome Measurements |
End points were efficacy, morbidity, and clinical response.
Results |
CSEMSs were removed from 65 patients. Resolution of the BBS was confirmed in 59 of 65 patients (90%) after a median follow-up of 12 months after removal (range 3-26 months). If patients who were lost to follow-up, developed cancer, or expired were considered failures, then an intent-to-treat global success rate of 59 of 79 (75%) was obtained. Complications associated with placement included 3 post-ERCP pancreatitis (4%), 1 postsphincterotomy bleed (1%), and 2 pain that required CSEMS removal (2%). In 11 patients (14%), the CSEMS migrated. In 1 patient, CSEMS removal was complicated by a bile leak that was successfully managed with plastic stents.
Limitation |
Pilot study from a single center.
Conclusions |
Temporary CSEMS placement in patients with BBS offers a potential alternative to surgery.
Le texte complet de cet article est disponible en PDF.Abbreviations : ALK, ALT, BBS, CSEMS, LFT, SEMS
Plan
| Presented at Digestive Disease Week, Chicago, Illinois, May 14-18, 2005, and Washington, DC, May 20-23, 2007 (Gastrointest Endosc 2005;61:AB208, Gastrointest Endosc 2007;65:AB123). |
Vol 67 - N° 3
P. 446-454 - mars 2008 Retour au numéro
Article précédent
- EUS-FNA in unresectable cholangiocarcinoma: a novel indication
- Michael J. Pollack, Pierre M. Gholam, Amitabh Chak
- Covered self-expanding metal stents in benign biliary strictures: not yet a “new paradigm” but a promising alternative
- Guido Costamagna
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