Temporary placement of fully covered self-expandable metal stents in benign biliary strictures

midterm evaluation (with video)

Anshu Mahajan, Henry Ho, Bryan Sauer, Melissa Lapinska, Vanessa M. Shami, Kristi Ellen, Michele Rehan, Timothy M. Schmitt, Michel Kahaleh

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.

Original languageEnglish (US)
Pages (from-to)303-309
Number of pages7
JournalGastrointestinal Endoscopy
Volume70
Issue number2
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

Fingerprint

Pathologic Constriction
Stents
Plastics
Self Expandable Metallic Stents
Metals
Sclerosing Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Liver Function Tests
Chronic Pancreatitis
Gallstones
Tertiary Care Centers
Pancreatitis
Hyperplasia
Drainage
Tooth
Morbidity
Transplants
Safety
Liver

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Temporary placement of fully covered self-expandable metal stents in benign biliary strictures : midterm evaluation (with video). / Mahajan, Anshu; Ho, Henry; Sauer, Bryan; Lapinska, Melissa; Shami, Vanessa M.; Ellen, Kristi; Rehan, Michele; Schmitt, Timothy M.; Kahaleh, Michel.

In: Gastrointestinal Endoscopy, Vol. 70, No. 2, 01.08.2009, p. 303-309.

Research output: Contribution to journalArticle

Mahajan, Anshu ; Ho, Henry ; Sauer, Bryan ; Lapinska, Melissa ; Shami, Vanessa M. ; Ellen, Kristi ; Rehan, Michele ; Schmitt, Timothy M. ; Kahaleh, Michel. / Temporary placement of fully covered self-expandable metal stents in benign biliary strictures : midterm evaluation (with video). In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 2. pp. 303-309.
@article{7547a47ba8a9402e9a87fb545eb4c3bb,
title = "Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video)",
abstract = "Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83{\%}) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14{\%}) patients after CSEMS placement and in 4 (9{\%}) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.",
author = "Anshu Mahajan and Henry Ho and Bryan Sauer and Melissa Lapinska and Shami, {Vanessa M.} and Kristi Ellen and Michele Rehan and Schmitt, {Timothy M.} and Michel Kahaleh",
year = "2009",
month = "8",
day = "1",
doi = "10.1016/j.gie.2008.11.029",
language = "English (US)",
volume = "70",
pages = "303--309",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Temporary placement of fully covered self-expandable metal stents in benign biliary strictures

T2 - midterm evaluation (with video)

AU - Mahajan, Anshu

AU - Ho, Henry

AU - Sauer, Bryan

AU - Lapinska, Melissa

AU - Shami, Vanessa M.

AU - Ellen, Kristi

AU - Rehan, Michele

AU - Schmitt, Timothy M.

AU - Kahaleh, Michel

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.

AB - Background: Benign biliary strictures (BBS) have been endoscopically managed with placement of multiple plastic stents. Uncovered metal stents have been associated with mucosal hyperplasia and partially covered self-expandable metal stents with migration. Recently, fully covered self-expandable metal stents (CSEMSs) with anchoring fins have become available. Objective: Our purpose was to analyze the efficacy and complication rates of CSEMSs in the treatment of BBS. Design: CSEMSs (10-mm diameter) were placed in 44 patients with BBS. CSEMSs were left in place until adequate biliary drainage was achieved, confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting: Tertiary care center with long-standing experience with metal stents. Patients: A total of 44 patients with BBS (28 men, median age 53.5 years) were included. The preprocedure diagnoses included chronic pancreatitis (n = 19), gallstone-related strictures (n = 14), post liver transplant (n = 9), autoimmune pancreatitis (n = 1), and primary sclerosing cholangitis (n = 1). Intervention: ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or rat tooth. Main Outcome Measurements: Stricture resolution and morbidity. Results: The median time of CSEMS placement was 3.3 months (interquartile range 3.0-4.8). Resolution of the BBS was confirmed in 34 of 41 patients (83%) after a median postremoval follow-up time of 3.8 months (interquartile range 1.2-7.7). Complications were observed in 6 (14%) patients after CSEMS placement and in 4 (9%) after CSEMS removal. Limitation: Pilot study from a single center. Conclusion: Temporary placement of CSEMSs for BBS may offer an alternative to plastic stenting. Further investigation is required to further assess safety and long-term efficacy.

UR - http://www.scopus.com/inward/record.url?scp=67651001738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651001738&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2008.11.029

DO - 10.1016/j.gie.2008.11.029

M3 - Article

VL - 70

SP - 303

EP - 309

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 2

ER -