Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

Abstract

Endoscopists frequently encounter severe tight strictures during therapeutic endoscopic retrograde cholangiopancreatography. Dilation using a Soehendra stent retriever (SSR) can be the approach of choice. However, reports of SSR use for the aforementioned strictures are scant. Patients presenting with strictures of the biliary or pancreatic ducts between July 2015 and March 2019 were prospectively screened. The aforementioned strictures allowed the passage of only a guidewire but denied 5.5‐French (Fr) catheter advancement and conventional balloon or catheter dilation. After guidewire passage and endoscopic sphincterotomy, an (7‐Fr) SSR was screwed clockwise over a guidewire and advanced progressively to traverse and dilate the stricture proximally. A plastic stent was then placed in the biliary or pancreatic duct for internal drainage. The stricture and procedural characteristics and immediate postprocedural status were analyzed. Eleven patients (nine men and two women; median age 58 [range 43‐75] years) with severe benign strictures of the biliary (n = 5) or pancreatic (n = 6) ducts were included. The median length of the strictures was 5 (range 2‐9) mm. All 11 severe strictures were successfully dilated using an SSR followed by stenting with a plastic stent (range 5‐7 Fr). Only one patient had brief minor hemobilia immediately after the procedure, and another briefly experienced acute cholangitis. Five (5/6, 83.3%) patients in the pancreatic group eventually achieved stent removal. None of the patients achieved stent removal in the biliary duct group until the end of follow‐up. Nonetheless, the patients did not require percutaneous or surgical interventions. Dilation using the SSR is safe, tolerable, and successful for the tight biliary and pancreatic duct strictures that defy conventional wire‐guided endoscopic access.

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“…Sometimes, tight strictures allowed only guidewire access, but defied 5.5‐Fr catheter advancement and conventional balloon dilation. In this situation, Chen et al reported the usage of Soehendra stent retriever (SSR; Cook Medical Inc., Winston‐Salem, NC) to screw such tight strictures followed by conventional balloon dilation . In the case series, all severe duct strictures were successfully dilated using an SSR followed by balloon dilation and stenting with plastic stents.…”

“…In this situation, Chen et al reported the usage of Soehendra stent retriever (SSR; Cook Medical Inc., Winston-Salem, NC) to screw such tight strictures followed by conventional balloon dilation. 12 In the case series, all severe duct strictures were successfully dilated using an SSR followed by balloon dilation and stenting with plastic stents. One patient (9.1%) briefly experienced a minor complication of hemobilia immediately after the procedure.…”