T1519: Use of Fully Covered Self Expanding Metal Stents (FCSEMS) in the Management of Benign Biliary Diseases (BBD)

Brijbassie, Alan; Stevens, Peter D.; Sethi, Amrita; Sejpal, Divyesh V.; Raijman, Isaac; Loren, David E.; Kowalski, Thomas E.; Patel, Sandeep; Poneros, John M.; Talreja, Jayant P.; Sauer, Bryan G.; Kahaleh, Michel

doi:10.1016/j.gie.2010.03.732

Cited by 4 publications

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“…Endoscopic placement of biliary plastic stents has long been widely accepted as the treatment of choice for benign biliary stricture and leaks. Recent data, however, have shown that covered SEMS (CSEMS) may offer benefits and can be used for these conditions ( 6 , 7 , 13 - 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Role of Fully Covered Self-Expandable Metal Stent for Treatment of Benign Biliary Strictures and Bile Leaks

2012

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Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant biliary strictures given the long duration of stent patency owing to their larger stent diameter. Recently, SEMS has been used in a variety of benign biliary strictures and leaks, especially with the design of the covered self-expandable metal stent (CSEMS), which permits endoscopic-mediated stent removal. The use of CSEMS in benign biliary stricture could potentially result in a decrease in endoscopic sessions and it is technically easier when compared to placement of multiple plastic stents. However, complications such as cholecystitis due to blockage of cystic duct, stent migration, infection and pancreatitis have been reported. The potential subsegmental occlusion of contralateral intrahepatic ducts also limits the use of CSEMS in hilar stricture. Certain techniques and improvement of stent design may overcome these challenges in the future. Thus, CSEMS may be appropriate in only highly selected conditions, such as refractory benign biliary stricture, despite multiple plastic stent placement or difficult to treat bile duct stricture from chronic pancreatitis, and should not be used routinely. This review focuses on the use of fully covered self-expandable metal stent for benign biliary strictures and bile leaks.

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Section: Introductionmentioning

confidence: 99%

“…Brijbassie et al ( 16 ) conducted a multicenter retrospective study of 59 patients with chronic pancreatitis using Wallflex stents. Stents were removed and stricture resolution rate was 88.9% demonstrated by imaging, 91.4% documented by laboratory findings, 78.5% based on symptoms, and 85.7% by direct visualization by choledochoscopy.…”

Section: Introductionmentioning

confidence: 99%