Treatment of Benign Biliary Strictures in Chronic Pancreatitis by Self-Expandable Metal Stents

Kahl, Stefan; Zimmermann, Sandra; Glasbrenner, Bernhard; Pross, M.; Schulz, Hans–Ulrich; McNamara, Deirdre; Malfertheiner, Peter

doi:10.1159/000067487

Cited by 41 publications

(15 citation statements)

References 11 publications

(13 reference statements)

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“…A single plastic stent was compared with multiple plastic stents in one non-randomized study [64]. The remaining studies were all case series, of which 33 were retrospective[16,21-29,31,35-37,39,41-44,47,49-51,53-55,59,60,62,64] and 14 prospective in design[15,30,32,34,38,40,45,48,52,56-58,61,63]…”

Section: Resultsmentioning

confidence: 99%

Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

2009

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BackgroundBenign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred.MethodsA systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical success and complications.ResultsIn total, 47 studies (1116 patients) on outcome of stent placement were identified. No randomized controlled trials (RCTs), one non-randomized comparative studies and 46 case series were found. Technical success was 98,9% for uncovered self-expandable metal stents (uSEMS), 94,8% for single plastic stents and 94,0% for multiple plastic stents. Overall clinical success rate was highest for placement of multiple plastic stents (94,3%) followed by uSEMS (79,5%) and single plastic stents (59.6%). Complications occurred more frequently with uSEMS (39.5%) compared with single plastic stents (36.0%) and multiple plastic stents (20,3%).ConclusionBased on clinical success and risk of complications, placement of multiple plastic stents is currently the best choice. The evolving role of cSEMS placement as a more patient friendly and cost effective treatment for benign biliary strictures needs further elucidation. There is a need for RCTs comparing different stent types for this indication.

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Section: Resultsmentioning

confidence: 99%

Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

2009

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“…[12][13][14][15][16][17][18][19][20] Optimal time for FC-SEMS removal is maybe between 4 months and 6 months, unless there are not enough data.…”

Section: Fully Covered Semsmentioning

confidence: 99%

Endoscopic approach to benign biliary obstruction

Tringali

Bove

Costamagna

2015

Gastrointestinal Intervention

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a b s t r a c tDuring the past 30 years, the endoscopic approach to benign biliary strictures (BBS) became the preferred "mini-invasive" treatment modality for benign diseases. Endoscopic plastic or metallic stenting, and balloon dilation represent the gold standard treatment for BBS. Side-by-side insertion of multiple plastic stents is a very effective treatment option for BBS following cholecystectomy or liver transplantation. This strategy has a low recurrence rate on long-term follow-up, with better results than fully covered self-expandable metal stents (FC-SEMS). FC-SEMS seems to have an advantage and higher stricture resolution rate in patients with BBS secondary to chronic pancreatitis. Dilation of dominant biliary strictures in patients with primary sclerosing cholangitis has a lower rate of infective complications than the stenting treatment. Endoscopic retrograde cholangiopancreatography represents a safe and effective approach to BBS, with a very high success rate, especially when such cases are managed in a multidisciplinary setting.

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“…Also, SEMS may be useful as a "temporary bridge" to surgery in selected patients. In five published series, SEMS were deployed in patients with chronic pancreatitis and biliary stricture that did not respond to serial plastic stenting or in patients unfit for or unwilling to have surgery [9][10][11][12][13] (see Table 3). The success rate was quite variable (37%-100%), with lowest patency rate seen in the only study in which a covered SEMS was deployed [12].…”

Section: Endoscopic Therapymentioning

confidence: 99%

Benign biliary strictures related to chronic pancreatitis: Balloons, stents, or surgery

Arslanlar¹,

Jain

2007

Curr Treat Options Gastro

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Benign biliary strictures are seen in a subset of patients with chronic pancreatitis. Most patients are asymptomatic and require no intervention. In some patients, benign strictures can become symptomatic. In these patients, the aim of biliary drainage is to prevent long-term complications such as recurrent cholangitis and secondary biliary cirrhosis. The possibility of a malignant stricture should always be excluded. Successful endoscopic drainage of biliary obstruction has no influence on pain pattern in patients with chronic pancreatitis. At the first diagnosis of a symptomatic biliary stricture due to chronic pancreatitis, a polyethylene stent can be inserted endoscopically. If the stricture is still present despite stent exchange with serial insertion of multiple stents every 3 months for 1 year, surgery is indicated as definitive treatment. The role of self-expandable metal stents in the management of benign biliary strictures due to chronic pancreatitis is unclear, but they may be useful for nonoperative candidates and a select group of patients in whom surgery is planned. The aim of surgical therapy is to definitively treat the benign biliary stricture, especially in younger patients, who presumably have a longer lifespan.

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Treatment of Benign Biliary Strictures in Chronic Pancreatitis by Self-Expandable Metal Stents

Cited by 41 publications

References 11 publications

Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

Endoscopic approach to benign biliary obstruction

Benign biliary strictures related to chronic pancreatitis: Balloons, stents, or surgery

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