Clinical Epidemiology and Ageing

Temporary placement of fully covered self-expandable metal stents for the treatment of benign biliary strictures.

Chaput U, Vienne A, Audureau E, Bauret P, Bichard P, Coumaros D, Napoléon B, Ponchon T, Duchmann J-C, Laugier R, Lamouliatte H, Védrenne B, Gaudric M, Chaussade S, Robin F, Leblanc S, Prat F United European Gastroenterol J. 2016;4(3):403-12.

<p><b>BACKGROUND: </b>Endoscopic treatment of benign biliary strictures (BBS) can be challenging.</p><p><b>OBJECTIVE: </b>To evaluate the efficacy of fully covered self-expandable metal stents (FCSEMS) in BBS.</p><p><b>METHODS: </b>Ninety-two consecutive patients with BBS (chronic pancreatitis (n = 42), anastomotic after liver transplantation (n = 36), and post biliary surgical procedure (n = 14)) were included. FCSEMS were placed across strictures for 6 months before endoscopic extraction. Early success rate was defined as the absence of biliary stricture or as a minimal residual anomaly on post-stent removal endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes were the final success and stricture recurrence rates as well as procedure-related morbidity.</p><p><b>RESULTS: </b>Stenting was successful in all patients. Stenting associated complications were minor and occurred in 22 (23.9%) patients. Migration occurred in 23 (25%) patients. Stent extraction was successful in all but two patients with proximal stent migration. ERCP after the 6 months stenting showed an early success in 84.9% patients (chronic pancreatitis patients: 94.7%, liver transplant: 87.9%, post-surgical: 61.5%) (p = 0.01). Final success was observed in 57/73 (78.1%) patients with a median follow-up of 12 ± 3.56 months. Recurrence of biliary stricture occurred in 16/73 (21.9%) patients.</p><p><b>CONCLUSIONS: </b>FCSEMS placement is efficient for patients with BBS, in particular for chronic pancreatitis patients. Stent extraction after 6 months indwelling, although generally feasible, may fail in a few cases.</p>

DOI: 10.1177/2050640615606550