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A US Multicenter Study of Safety and Efficacy of Fully Covered Self-Expandable Metallic Stents in Benign Extrahepatic Biliary Strictures

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Abstract

Background

Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges.

Aims

The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS.

Methods

A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded.

Results

A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57 % were males. Stricture resolution occurred in 81 % of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7 %) was the most common complication, followed by stent occlusion (4.9 %), cholangitis (4.1 %), and pancreatitis (3.3 %). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis.

Conclusions

Majority of BBS can be successfully managed with 1–2 consecutive FCSEMS with stent dwell time of 6 months.

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Conflict of interest

Payal Saxena is a consultant for Boston Scientific and has received research support from Cook Medical and consultancy fees from Olympus. David L. Diehl is a consultant for Boston Scientific and Olympus. Jonathan M Buscaglia is a consultant for Boston Scientific. Mouen A. Khashab is a consultant for Boston Scientific and Olympus and has received research support from Cook Medical. Anthony Kalloo is a founding Member, equity Holder, and consultant for Apollo Endosurgery. Vikesh K. Singh is a consultant for Abbvie, Santarus, D-Pharm, and Boston Scientific. Anne Marie Lennon is a consultant for Boston Scientific. All other authors have no relevant conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Payal Saxena, Vivek Kumbhari, Eun Ji Shin, Vikesh Singh, Anne Marie Lennon, Anthony N. Kalloo & Mouen A. Khashab

  2. Lifehouse at Royal Prince Alfred Hospital, 119 Missenden Rd, Campberdown, NSW, 2050, Australia

    Payal Saxena

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Geisinger Health System, Danville, PA, USA

    David L. Diehl & Frederick Shieh

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jonathan M. Buscaglia, Wilson Sze & Sumit Kapoor

  5. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA

    Srinadh Komanduri

  6. Division of Gastroenterology and Hepatology, Department of Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA

    John Nasr

  7. Johns Hopkins Hospital, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA

    Mouen A. Khashab

Authors
  1. Payal Saxena
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  2. David L. Diehl
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  3. Vivek Kumbhari
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  5. Jonathan M. Buscaglia
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  7. Sumit Kapoor
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  8. Srinadh Komanduri
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  9. John Nasr
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  10. Eun Ji Shin
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  11. Vikesh Singh
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  12. Anne Marie Lennon
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  13. Anthony N. Kalloo
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  14. Mouen A. Khashab
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Corresponding author

Correspondence to Payal Saxena.

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Saxena, P., Diehl, D.L., Kumbhari, V. et al. A US Multicenter Study of Safety and Efficacy of Fully Covered Self-Expandable Metallic Stents in Benign Extrahepatic Biliary Strictures. Dig Dis Sci 60, 3442–3448 (2015). https://doi.org/10.1007/s10620-015-3653-5

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  • DOI: https://doi.org/10.1007/s10620-015-3653-5

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