Novel biliary self-expanding metal stents: indications and applications

Abstract

Endoscopic insertion of a self-expanding metal stent (SEMS) through a malignant common bile duct stricture is the first line of palliation for malignant jaundice. Patency of these stents remains a major concern. SEMS dysfunction can result from tumor ingrowth, overgrowth and/or clogging. Initial SEMS modifications involved covering the central part of the stent in order to reduce ingrowth and ultimately increase patency. Fully covered stents became available shortly after reports of their use in human patients. The potential removability and radial strength of SEMS have led to evaluation of their use in new indications including benign biliary strictures, post sphincterotomy bleeding and perforation. Other aspects of development include the addition of features such as anti-reflux valves, drug elution and spontaneous biodegradability. These aspects and their clinical implications are reviewed and discussed.

Endoscopic management of malignant biliary stenosis. Update and highlights for standard clinical practice

“…Their successful placement rate is similar to that of plastic stents but they also last longer, have fewer complications, reduce hospital admissions and mean stay, decrease the number of endoscopic procedures, and diminish overall costs (1,2,10,17,18).…”

“…This type of metallic stents is the only one to be used for hilar lesions. However, these stents represent just an option among the other types for lesions in the distal bile duct (1,2,11,12,17).…”

“…They should not be used for hilar lesions since they may occlude collateral or intrahepatic branches, and trigger acute cholangitis. Furthermore, at the distal level cholecystitis and acute pancreatitis events have been described that may limit their use (1,2,17).…”

“…In no patient was migration found to be the cause of stent dysfunction, regardless of stent type (20). Recent studies also advocate for this anti-migration system in order to minimize stent dysfunction rates secondary to metallic stent mobility (1,25).…”

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

“…2,3 Other emerging indications for the use of FC-SEMS are (but not limited to) post-sphincterotomy bleeding, esophageal variceal bleeding, sealing of a perforation or bile leak and lately treatment of symptomatic biliary and pancreatic duct strictures. 4,5 Temporary placement of FC-SEMS can also be used to treat benign non-obstructive conditions in the GI tract, such as oesophageal and colonic fistulas. 6 In recent years, endoscopic ultrasound (EUS) has emerged as a mainstream therapeutic modality for drainage and fine-needle injection.…”