Endoscopic treatment for benign biliary strictures: Can placement of a covered metallic stent be an option in refractory cases?

Abstract

Background : Recently, endoscopic treatment has been attempted to counter benign biliary strictures. It is expected to be an alternative to surgical operation because of its lower morbidity and its convenience, but the long-term results have not yet been sufficiently elucidated. Here, we evaluate the short-and long-term results of endoscopic stenting in patients with benign biliary strictures, and also describe a new technique using a covered metallic stent (CMS) in the refractory cases. Methods : The charts of 22 consecutive patients with benign biliary stricture treated endoscopically at our institutions between December 1995 and December 2002 were analyzed retrospectively. Results : Stricture etiology was as follows: postoperative, nine; chronic pancreatitis, seven; primary sclerosing cholangitis (PSC), three; and other, three. The stent initially placed was a 7 Fr in 11 patients and a 10 Fr in 11 patients. Eighteen of 22 patients (82%) were successfully treated by the initial treatment, and stents were removed after a mean duration of 3.1 months (range: 1-14 months). In the remaining four patients, stents were exchanged once to four times after that, and a CMS was placed as the second endoprosthesis in two patients with chronic pancreatitis. These stents, including CMS, were finally removed from these four patients after a mean duration of 14.8 months (range: 8-22 months). Over a median followup period of 26 months (range: 6-78 months), one recurrence has been observed, in which case a CMS was placed in a patient with chronic pancreatitis. The CMS was removed successfully 6 months after the insertion, and no recurrence was observed during the 6-month follow-up period. Conclusions : Endoscopic stenting for benign biliary stricture is an alternative to surgery because it shows satisfactory results. Placement of a CMS would also be an option in refractory strictures, such as those due in chronic pancreatitis, if the certainty of removal is proven by cumulative experience with a large number of patients.

Fully covered self-expandable metal stents for treatment of benign biliary strictures

“…12 Cholangitis resulting from biliary obstruction secondary to either stent migration or occlusion has been reported in some studies. The published cholangitis rates of 5% to 14% for FCSEMSs in BBSs 13,21,25,27 are not dissimilar to rates quoted in studies of PSs. 34 All patients described in FC-SEMS studies were treated successfully by using antibiotics with or without further endoscopic procedures.…”

“…Most studies of FCSEMSs in BBSs observed pancreatitis in 0 to 6% of patients, 11,13,22,25,26,28,30 which is on a par with rates of routine ERCP. 32,33 Elevated rates of up to 14% to 18% have been reported by groups that have used FCSEMSs with anchoring fins.…”

“…7,11,12,20,25,27,28,30,31 Although much variation exists between studies, the most common adverse events described include periprocedural pancreatitis, cholangitis, pain, secondary strictures, and stent migration. Stent migration is discussed separately in the following.…”

“…Although an early study by Cahen et al 10 of only 6 patients reported a removal rate of only 67% (4 of 6 patients), subsequent studies have consistently reported high removal rates of 98% to 100%. 11,13,[25][26][27][28]30,35 Patients with stent retention, which often occurs in the setting of stent migration, may require additional procedures such as balloon dilation and sweeping, use of a polypectomy snare, or even surgery to achieve retrieval. 10,11 Of the 2 patients described by Cahen et al, 10 whose stents (Hanaro; M.I.…”

Temporary Placement of Covered Self‐expandable Metallic Stents in the Management of Benign Biliary Strictures

“…We initially reported the short‐term outcomes of three patients who underwent C‐SEMS placement in 2003 12 . In this study, we report the efficacy of C‐SEMS placement for benign biliary strictures in a larger number of subjects with longer follow‐up periods.…”