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Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Disclosures

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.

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Authors and Affiliations

  1. Faculty of Medical Sciences, Department of Gastroenterology, Pulido Valente Hospital, Lisbon, Portugal

    Jorge Canena, Carlos Romão & António Coutinho

  2. Center of Gastroenterology, Cuf Infanto Santo Hospital, Travessa do Castro nº 3, 1350-070, Lisbon, Portugal

    Jorge Canena, Manuel Liberato, David Horta & António Coutinho

  3. Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal

    Jorge Canena & David Horta

  4. Department of Endoscopy, José Joaquim Fernandes Hospital, Beja, Portugal

    Jorge Canena

Authors
  1. Jorge Canena
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  2. Manuel Liberato
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  3. David Horta
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  4. Carlos Romão
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  5. António Coutinho
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Corresponding author

Correspondence to Jorge Canena.

Electronic supplementary material

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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)

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Canena, J., Liberato, M., Horta, D. et al. Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations. Surg Endosc 27, 313–324 (2013). https://doi.org/10.1007/s00464-012-2368-3

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  • DOI: https://doi.org/10.1007/s00464-012-2368-3

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