TY - JOUR
T1 - Temporary placement of fully covered self-expandable metal stents in benign biliary strictures
T2 - midterm evaluation (with video)
AU - Mahajan, Anshu
AU - Ho, Henry
AU - Sauer, Bryan
AU - Phillips, Melissa S.
AU - Shami, Vanessa M.
AU - Ellen, Kristi
AU - Rehan, Michele
AU - Schmitt, Timothy M.
AU - Kahaleh, Michel
N1 - Funding Information:
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: M. Kahaleh has received grant support from Boston Scientific, Olympus, Alveolus, Conmed, and Cook Medical. All other authors disclosed no financial relationships relevant to this publication.
Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2009/8
Y1 - 2009/8
N2 - Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.
AB - Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.
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U2 - 10.1016/j.gie.2008.11.029
DO - 10.1016/j.gie.2008.11.029
M3 - Article
C2 - 19523620
AN - SCOPUS:67651001738
SN - 0016-5107
VL - 70
SP - 303
EP - 309
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -