Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures (with videos)

Lee, Moon Sung; Koo, Hyun Cheol; Han, Seung Hyo; Lee, Tae Hoon; Cho, Young Deok; Park, Sang‐Heum; Kim, Sun‐Joo

doi:10.1016/j.gie.2012.01.016

Cited by 71 publications

(75 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Safety and Removabilitymentioning

confidence: 99%

“…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.…”

Section: Fcsemss For Benign Biliary Stricturesmentioning

confidence: 99%

“…Both patients had functional biliary drainage at more than 30 months of follow up. To facilitate stent removal, various stents 13,24,26,29 have also been modified with either lassos or long retrieval wires, which can be grasped with grasping forceps or a snare. The retrieval rates reported in these studies were all 100%.…”

Section: Fcsemss For Benign Biliary Stricturesmentioning

confidence: 99%

See 2 more Smart Citations

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

Kaffes

Liu

2013

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Section: Safety and Removabilitymentioning

confidence: 99%

Section: Fcsemss For Benign Biliary Stricturesmentioning

confidence: 99%

Section: Fcsemss For Benign Biliary Stricturesmentioning

confidence: 99%

See 1 more Smart Citation

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

Kaffes

Liu

2013

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

“…Few reports have focused on the clinical use of covered SEMS for post-LDLT biliary strictures [97][98][99]. Jang et al retrospectively evaluated the efficacy and safety of covered SEMS in 35 LDLT patients with refractory biliary strictures [99].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

View full text Add to dashboard Cite

Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

show abstract

“…A modified FCSEMS, placed intraductally through the strictured segment to minimize stent-induced complications has been reported [13]. In our experience, intraductal placement of a short FCSEMS for a BBS in patients who had undergone living-related LT was not associated with stent-induced bile duct injury, including de novo stricture formation or cholangitis.…”

mentioning

confidence: 62%

Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Lee

2013

Dig Dis Sci

Self Cite

View full text Add to dashboard Cite

Benign biliary strictures (BBS) may complicate biliary surgery including liver transplantation (LT) [1]. The firstline management of BBS, including anastomotic strictures after LT, now incorporates endoscopic therapy, mostly consisting of stenting [2]. Although originally designed for endoscopic palliation of malignant biliary strictures, the self-expandable metallic stent (SEMS) is a valid alternative to surgery for BBS. Patients with malignant biliary strictures who undergo treatment with metal stents have a limited life expectancy due to the poor prognosis of the underlying disease. Therefore, for patients with BBS who have a normal life expectancy, the indications for metal stent placement should differ from those applied to malignant biliary strictures.Metal stents can be divided into uncovered SEMS, partially covered SEMS, and fully covered SEMS (FCS-EMS). Non-removable uncovered SEMS cannot be used for BBS due to their limited patency, since reactive hyperplastic tissue may extend through the metal mesh. Partially covered SEMS can be used for BBS to decrease the rate of stent migration; however, the uncovered portion can embed in the bile duct wall. FCSEMS are a good first choice because of their easy removal and long duration of patency due to lack of tissue hyperplasia and implantation into the biliary tree. Since frequent spontaneous stent migration is a major adverse event associated with FCS-EMS, an anchoring system such as flared ends or anchoring fins has been developed [3].In this issue of Digestive Diseases and Sciences, Kahaleh's group reports the retrospectively analyzed outcomes of covered SEMS for 55 patients with anastomotic strictures after LT [4]. Twenty-seven of 55 (49.1 %) patients were treated with plastic stents prior to covered SEMS. The authors applied three different types of covered SEMS: partially covered SEMS (19 patients), FCSEMS with anchoring fins (21 patients), and FCSEMS with flared ends (15 patients). Endoscopic biliary sphincterotomy was performed in all patients. Although the authors endeavored to center the stent within the stricture, success was not universal. All covered SEMS were removed after 3-4 months. The technical success rate was 100 %, but the clinical success rate, as measured by stricture resolution, was unsatisfactory (60-74 %). Even after covered SEMS placement, three (5.5 %) patients eventually required surgery to resolve their biliary strictures. Notably, the stentrelated adverse event rate involving migration and occlusion was 7-24 %. Five patients with early stent occlusion required repeat stenting. Indeed, the clinical success rate of endoscopic stenting with multiple plastic stents is reportedly 87-94 % [5].The location of the stricture is usually the most proximal aspect of the common hepatic duct in anastomotic strictures after LT, especially after living-related LT recipients, in whom the strictured segment is usually short. To achieve effective stenting with covered SEMS, the stent should be centered within the strictured bile duct segment, which ...

show abstract

Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures (with videos)

Cited by 71 publications

References 20 publications

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

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

Endoscopic management of biliary strictures after living donor liver transplantation

Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Contact Info

Product

Resources

About