Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations
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Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations.
This was a retrospective case series with long-term follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development.
Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7–28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3–15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21–30 days). There were no complications related to stenting.
Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late complications.
KeywordsFully covered self-expandable metal stents Refractory biliary leaks Benign biliary tract conditions Endoscopic retrograde cholangiopancreatography Postsphincterotomy bleeding Duodenal perforations
Jorge Canena is a consultant for Boston Scientific but did not receive any financial arrangements related to this research or assistance with manuscript preparation. The remaining authors disclose no conflicts.
Video 1. Normal cholangiography and normal cholangioscopy 24 weeks after fully covered self-expandable metal stent removal, used to treat a cystic-stump leak after unsuccessful endoscopic treatment with sphincterotomy and plastic stent placement. Note clear endoscopic image of cystic stump after visualization of hilar bifurcation (MPG 3388 kb)
Video 2. Cholangiography and cholangioscopy 90 weeks after fully covered self-expandable metal stent removal, used to treat a common bile duct/common hepatic duct leak with associated stricture. Note the endoscopic appearance of a minor stricture (fibrous ring) and the normality of the bile duct above the stricture (MPG 2950 kb)
- 3.Garcia-Cano J, Taberna-Arana L, Jimeno-Ayllón C, Martínez-Fernández R, Serrano-Sanchez L, Reyes-Guevara A, Viñuelas-Chicano M, Gómez-Ruiz C, Morillas-Ariño M, Pérez-Garcia J, Pérez-Vigara G, Pérez-Sola A (2010) Use of fully-covered self-expandable metallic stents for the management of benign biliary conditions. Rev Esp Enferm Dig 102:526–532PubMedGoogle Scholar
- 13.Cozzi G, Severini A, Civelli E, Millela M, Pulvirenti A, Salvetti M, Romito R, Suman L, Chiaraviglio F, Mazzaferro V (2006) Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 29:380–388PubMedCrossRefGoogle Scholar
- 27.Park D, Lee S, Lee T, Ryu C, Kim H, Seo DW, Park SH, Lee SK, Kim MH, Kim SJ (2011) Anchoring flaps versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos). Gastrointest Endosc 73:64–70PubMedCrossRefGoogle Scholar