Massive hemobilia during extraction of a covered self-expandable metal stent in a patient with portal hypertensive biliopathy

Endoscopic Management of Portal Cavernoma Cholangiopathy: Practice, Principles and Strategy

“…Since the first report of biliary stenting for choledochal stenosis in 1993, 6 endoscopic management of symptomatic PCC has been reported in at least 87 patients in 17 case series, 6,[8][9][10][11][12][13]22,[24][25][26][27][28][29][30][31][32] nine of which involved fewer than 4 patients and the largest included 20 patients (Table 2). Results of endoscopic management for biliary stenoses are summarized below.…”

“…Ajayi 29 reported a 'good outcome' in a Nigerian patient treated with stent exchanges for 6 months. Layec 30 placed a selfexpandable metal stent in a French patient with symptomatic PCC and reported a 'good outcome' at 18 months with stent in situ. Cantu 31 reported that a 'stent-trial' with a single stent placed for 3 months in a patient with a common bile duct stricture helped in establishing that obstruction was related to ischemic stricturing after which they resorted to surgical treatment and observed a 'good response' at 4 years.…”

“…10,30 Oo et al 10 have reported their experience of placing bare stents in three patients who had undergone repeated plastic stent exchanges, were not candidates for PSS or surgery had been unsuccessful, and in whom biliary access was difficult. While initial experience with selfexpandable metallic stents was satisfactory, obviating the need for frequent exchange of plastic stents, at least one patient developed stent occlusion after 6 years and had to be salvaged with regular exchange of plastic stents through the metal stent.…”

“…While initial experience with selfexpandable metallic stents was satisfactory, obviating the need for frequent exchange of plastic stents, at least one patient developed stent occlusion after 6 years and had to be salvaged with regular exchange of plastic stents through the metal stent. Layec et al 30 reported their experience with placement of a covered removable self-expandable metallic stent in a patient with symptomatic PCC. While the initial placement and course were uneventful, they encountered torrential bleeding along with a bile leak during attempted removal three months later and had to re- deploy a fresh covered metal stent to treat the complication.…”

“…16 Others did not implicate any one procedure, reporting minor episodes of hemobilia during balloon sweeps (2), Dormia sweeps (2) and removal of stent or nasobiliary catheter (2), which were controlled with terlipressin infusion. 17 Recently, covered removable selfexpanding metal stents have been placed for symptomatic PCC 10 but at least one report 30 documented torrential bleeding after stent removal, which could only be controlled with reinsertion of another covered metal stent.…”