Skip to main content
SpringerLink
Log in

Management of Complications Associated with Partially Covered Biliary Metal Stents

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background Partially covered metal stents (PCMS) have been increasingly used for both malignant and benign biliary indications. This study reports their complications and subsequent management. Methods Over 5 years, all patients receiving biliary PCMS were followed prospectively until stent-related dysfunction or death. Data were analyzed for the following variables: primary disease, time until revision, and type and reason for revision. Results PCMS were placed in 396 patients (247 with malignant biliary strictures and 149 with benign biliary disease). Complications were observed in 70 patients (18%), occurring a mean time following placement of 159 days. Duodenal migration occurred in 27 cases (6.8%), while proximal migration occurred in 9 cases (2.3%). Cholecystitis was documented in 13 cases (3.3%). There were six cases of stent occlusion due to debris or sludge (1.6%), four cases of pancreatitis (1%), four cases of tumor overgrowth (1%), three cases of benign stenosis in the uncovered portion of the PCMS (0.8%), two cases of abdominal pain (0.5%), one case of an infected biloma (0.3%), and one case of a liver abscess (0.3%). Conclusions Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Soehendra N, Reynders-Frederix V. Palliative bile duct drainage—a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980;12(1):8–11.

    Article  CAS  PubMed  Google Scholar 

  2. Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol and Hepatol. 2004;2(4):273–285.

    Article  Google Scholar 

  3. Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25(3):207–212.

    Article  CAS  PubMed  Google Scholar 

  4. Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  5. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340(8834–8835):1488–1492.

    Article  CAS  PubMed  Google Scholar 

  6. Arguedas MR, Heudebert GH, Stinnett AA, Wilcox CM. Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis. Am J Gastroenterol. 2002;97(4):898–904.

    Article  PubMed  Google Scholar 

  7. Shim CS, Lee YH, Cho YD, et al. Preliminary results of a new covered biliary metal stent for malignant biliary obstruction. Endoscopy. 1998;30(4):345–350.

    Article  CAS  PubMed  Google Scholar 

  8. Thurnher SA, Lammer J, Thurnher MM, Winkelbauer F, Graf O, Wildling R. Covered self-expanding transhepatic biliary stents: clinical pilot study. Cardiovasc Intervent Radiol. 1996;19(1):10–14.

    Article  CAS  PubMed  Google Scholar 

  9. Petersen BT. SEMS removal: salvage technique or new paradigms. Gastrointest Endosc. 2005;62(6):911–913.

    Article  PubMed  Google Scholar 

  10. Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic Wallstents. Gastrointest Endosc. 2004;60(4):640–644.

    Article  PubMed  Google Scholar 

  11. Familiari P, Bulajic M, Mutignani M, et al. Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc. 2005;62(6):903–910.

    Article  PubMed  Google Scholar 

  12. Kahaleh M, Brock A, Conaway MR, et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis. Endoscopy. 2007;39(4):319–324.

    Article  CAS  PubMed  Google Scholar 

  13. Mullen JT, Lee JH, Gomez HF, et al. Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg. 2005;9(8):1094–1105.

    Article  PubMed  Google Scholar 

  14. Carr-Locke DL. Metal stents for distal biliary malignancy: have we got you covered? Gastrointest Endosc. 2005;61(4):534–536.

    Article  PubMed  Google Scholar 

  15. Wamsteker EJ, Elta GH. Migration of covered biliary self-expanding metallic stents in two patients with malignant biliary obstruction. Gastrointest Endosc. 2003;58(5):792–793.

    Article  PubMed  Google Scholar 

  16. Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53(5):729–734.

    Article  CAS  PubMed  Google Scholar 

  17. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc. 2005;61(4):528–533.

    Article  PubMed  Google Scholar 

  18. Suk KT, Kim HS, Kim JW, et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc. 2006;64(4):522–529.

    Article  PubMed  Google Scholar 

  19. Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol. 2006;4(9):1148–1153.

    Article  PubMed  Google Scholar 

  20. Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344(22):1681–1687.

    Article  CAS  PubMed  Google Scholar 

  21. Born P, Neuhaus H, Rosch T, et al. Initial experience with a new, partially covered Wallstent for malignant biliary obstruction. Endoscopy. 1996;28(8):699–702.

    Article  CAS  PubMed  Google Scholar 

  22. Nakamura T, Hirai R, Kitagawa M, et al. Treatment of common bile duct obstruction by pancreatic cancer using various stents: single-center experience. Cardiovasc Intervent Radiol. 2002;25(5):373–380.

    Article  PubMed  Google Scholar 

  23. Nakai Y, Isayama H, Komatsu Y, et al. Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005;62(5):742–748.

    Article  PubMed  Google Scholar 

  24. Isayama H, Komatsu Y, Tsujino T, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002;55(3):366–370.

    Article  PubMed  Google Scholar 

  25. Cantu P, Hookey LC, Morales A, Le Moine O, Deviere J. The treatment of patients with symptomatic common bile duct stenosis secondary to chronic pancreatitis using partially covered metal stents: a pilot study. Endoscopy. 2005;37(8):735–739.

    Article  PubMed  Google Scholar 

  26. Bezzi M, Zolovkins A, Cantisani V, et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol. 2002;13(6):581–589.

    Article  PubMed  Google Scholar 

  27. Matsushita M, Takakuwa H, Nishio A, Kido M, Shimeno N. Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents. Gastrointest Endosc. 2003;58(6):924–927.

    Article  PubMed  Google Scholar 

  28. Minami A, Fujita R. A new technique for removal of bile duct stones with an expandable metallic stent. Gastrointest Endosc. 2003;57(7):945–948.

    Article  PubMed  Google Scholar 

  29. Miyayama S, Matsui O, Terayama N, Tatsu H, Yamamoto T, Takashima T. Covered gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol. 1997;8(4):641–648.

    Article  CAS  PubMed  Google Scholar 

  30. Sung JY, Shaffer EA, Costerton JW. Antibacterial activity of bile salts against common biliary pathogens Effects of hydrophobicity of the molecule and in the presence of phospholipids. Dig Dis Sci. 1993;38(11):2104–2112.

    Article  CAS  PubMed  Google Scholar 

  31. Coene PP, Groen AK, Cheng J, Out MM, Tytgat GN, Huibregtse K. Clogging of biliary endoprostheses: a new perspective. Gut. 1990;31(8):913–917.

    Article  CAS  PubMed  Google Scholar 

  32. Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G. Clinical experience with covered wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol. 1997;20(6):441–447.

    Article  CAS  PubMed  Google Scholar 

  33. Schoder M, Rossi P, Uflacker R, et al. Malignant biliary obstruction: treatment with ePTFE-FEP-covered endoprostheses initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225(1):35–42.

    Article  PubMed  Google Scholar 

  34. Hausegger KA, Thurnher S, Bodendorfer G, et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol. 1998;170(2):403–408.

    CAS  PubMed  Google Scholar 

  35. Ainley CC, Williams SJ, Smith AC, Hatfield AR, Russell RC, Lees WR. Gallbladder sepsis after stent insertion for bile duct obstruction: management by percutaneous cholecystostomy. Br J Surg. 1991;78(8):961–963.

    Article  CAS  PubMed  Google Scholar 

  36. Gregg JA, De Girolami P, Carr-Locke DL. Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct. Am J Surg. 1985;149(5):668–671.

    Article  CAS  PubMed  Google Scholar 

  37. Parker HW, Geenen JE, Bjork JT, Stewart ET. A prospective analysis of fever and bactermia following ERCP. Gastrointest Endosc. 1979;25(3):102–103.

    Article  CAS  PubMed  Google Scholar 

  38. Deviere J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangiopancreatography. Endoscopy. 1990;22(2):72–75.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Health Center, University of Virginia Health System, Charlottesville, Box 800708, VA, 22908-0708, USA

    Henry Ho, Anshu Mahajan, Sonia Gosain, Animesh Jain, Andrew Brock, Michele E. Rehan, Kristi Ellen, Vanessa M. Shami & Michel Kahaleh

Authors
  1. Henry Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anshu Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonia Gosain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Animesh Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michele E. Rehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kristi Ellen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vanessa M. Shami
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michel Kahaleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Kahaleh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ho, H., Mahajan, A., Gosain, S. et al. Management of Complications Associated with Partially Covered Biliary Metal Stents. Dig Dis Sci 55, 516–522 (2010). https://doi.org/10.1007/s10620-009-0756-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-009-0756-x

Keywords

Search

Navigation