Korean J Radiol.  2012 Feb;13(Suppl 1):S67-S73. 10.3348/kjr.2012.13.S1.S67.

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

Affiliations
  • 1Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  • 2Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. Rungsun@pol.net

Abstract

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.

Keyword

Biliary tract disease; Benign stricture; Stent

MeSH Terms

*Bile
Biliary Tract Diseases/diagnosis/etiology/*surgery
Coated Materials, Biocompatible
Constriction, Pathologic
Diagnostic Imaging
Equipment Design
Foreign-Body Migration
Humans
Metals
Plastics
Postoperative Complications
Sphincterotomy, Endoscopic
*Stents

Figure

  • Fig. 1 Results of pancreatic stent treatment in benign biliary striture of different etiologies. Maximum result in post-transplant stricture was found in anastomotic stricture whereas minimum result was found in non-anastomotic stricture. PSC = Primary sclerosing cholangitis, Max = Maximum percentage of response, Min = Minimum percentage of response

  • Fig. 2 Method to prevent fully covered stent migration. Double pigtail plastic stent was inserted as stent-in-stent to lock movement of fully covered metal stent.

  • Fig. 3 Method to provide subsegmental drainage when fully covered stent was inserted in benign biliary stricture near hepatic hilum. Plastic stent was inserted into contralateral intrahatic duct after small (6 × 120 mm) fully covered metal stent was inserted into left intrahepatic duct.


Cited by  1 articles

Current Status of Biliary Metal Stents
Hyeong Seok Nam, Dae Hwan Kang
Clin Endosc. 2016;49(2):124-130.    doi: 10.5946/ce.2016.023.


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