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Digestive Diseases and Sciences

, Volume 59, Issue 1, pp 152–160 | Cite as

Endoscopic Treatment of Benign Biliary Strictures Using Covered Self-Expandable Metal Stents (CSEMS)

  • Shayan Irani
  • Todd H. BaronEmail author
  • Ali Akbar
  • Otto S. Lin
  • Michael Gluck
  • Ian Gan
  • Andrew S. Ross
  • Bret T. Petersen
  • Mark Topazian
  • Richard A. Kozarek
Original Article

Abstract

Background and Aims

Traditional endoscopic management of benign biliary strictures (BBS) consists of placement of one or more plastic stents. Emerging data support the use of covered self-expandable metal stents (CSEMS). We sought to assess outcome of endoscopic temporary placement of CSEMS in patients with BBS.

Methods

This was a retrospective study of CSEMS placement for BBS between May 2005 and July 2012 from two tertiary care centers. A total of 145 patients (81 males, median age 59 years) with BBS were identified; 73 of which were classified as extrinsic and were caused by chronic pancreatitis, and 70 were intrinsic. Main outcome measures were resolution of stricture and adverse events (AEs) due to self-expandable metal stents (SEMS)-related therapy.

Results

Fully covered and partially covered 8–10 mm diameter SEMS were placed and subsequently removed in 121/125 (97 %) attempts in BBS (failure to remove four partially covered stents). Stricture resolution occurred in 83/125 (66 %) patients after a median stent duration of 26 weeks (median follow-up 90 weeks). Resolution of extrinsic strictures was significantly lower compared to intrinsic strictures (31/65, 48 % vs. 52/60, 87 %, p = 0.004) despite longer median stent duration (30 vs. 20 weeks). Thirty-seven AEs occurred in 25 patients (17 %), with 12 developing multiple AEs including cholangitis (n = 17), pancreatitis (n = 5), proximal stent migration (n = 3), cholecystitis (n = 2), pain requiring SEMS removal and/or hospitalization (n = 3), inability to remove (n = 4), and new stricture formation (n = 3).

Conclusions

Benign biliary strictures can be effectively treated with CSEMS. Successful resolution of biliary strictures due to extrinsic disease is seen significantly less often than those due to intrinsic disease. Removal is successful in all patients with fully covered SEMS.

Keywords

Benign biliary strictures Covered self-expandable metal stents Chronic pancreatitis 

Notes

Conflict of interest

Virginia Mason Medical Center receives restricted funding from Boston Scientific (BSCI), Cook Medical, and Olympus America Inc. for educational purposes. Dr. Petersen and Baron received research funding from BSCI.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shayan Irani
    • 1
  • Todd H. Baron
    • 2
    Email author
  • Ali Akbar
    • 2
  • Otto S. Lin
    • 1
  • Michael Gluck
    • 1
  • Ian Gan
    • 1
  • Andrew S. Ross
    • 1
  • Bret T. Petersen
    • 2
  • Mark Topazian
    • 2
  • Richard A. Kozarek
    • 1
  1. 1.Department of GastroenterologyVirginia Mason Medical CenterSeattleUSA
  2. 2.Division of Gastroenterology and HepatologyMayo Clinic RochesterRochesterUSA

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