Management of postendoscopic sphincterotomy bleeding with fully covered self‐expanding metal stent

Abstract

Postendoscopic sphincterotomy (ES) bleeding is one of the most frequent complications following ES. Different endoscopic interventions are available to manage post‐ES bleeding. Recently, the temporary placement of fully covered self‐expanding metal stent (FCSEMS) to achieve a tamponade effect has been described in post‐ES bleeding not controlled by other measures. The aim of this article is to present our clinical experience with management of post‐ES bleeding using FCSEMS. This is a retrospective analysis of prospectively collected data involving six patients who received FCSEMS for post‐ES bleeding after failure of traditional endoscopic interventions between the period of January 2013 and December 2016. Success of hemostasis and development of complications were evaluated. Successful hemostasis was achieved in all patients although one patient required additional endoscopic intervention after stent deployment. Two cases of pancreatitis were observed. There was no stent migration encountered. Temporary placement of FCSEMS is a safe and effective method to achieve hemostasis in post‐ES bleeding when primary endoscopic interventions failed. However, we should be aware of possible pancreatitis complications.

Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding

“…To our knowledge, this is the largest study reporting outcomes in patients treated with FCSEMS for EBS-related bleeding. Previous reports have described improved hemostasis rates with FCSEMS compared to other endoscopic interventions [20][21][22][23] While our study did not have a control arm, we observed durable hemostasis in the 94 % of patients undergoing FCSEMS. In addition, seven patients who were not managed with FCSEMS placement at the time of immediate EBS-related bleeding, were successfully managed with FCSEMS on subsequent ERCP.…”

“…Over the last decade, several series and small cohort studies have reported utilizing fully covered self-expanding metal stents (FCSEMS) to achieve hemostasis in severe cases of EBSrelated bleeding that were refractory to traditional management [18][19][20][21][22][23]. A recent retrospective study compared FCSEMS to traditional endoscopic modalities for the management of EBS-related bleeding after failure of traditional endoscopic modalities [20].…”

Treatment for postendoscopic sphincterotomy bleeding with fully covered self‐expanding metal stent: A feasible and safe method

“…Huang et al recently reported their own successful experience of treatment of post‐ES bleeding in Taiwan by using FCSEMS after failure of conventional endoscopic interventions within a 3‐year period. Immediate hemostasis was achieved in five of six patients except one, who needed an additional application of hemoclip to stop the bleeding.…”