Covered self-expanding metal stents for postoperative bile leaks: is the expense worth the expanse?

Fully covered, self-expandable metal stents for first-step endoscopic treatment of biliary leaks secondary to hepato-biliary surgery: a retrospective study

BACKGROUND

Fully covered self-expanding metal stents are now being used to treat benign biliary diseases.

AIMS

To assess the outcomes of these stents as first-step therapy in patients with biliary leaks secondary to hepato-biliary surgery.

METHODS

Thirty patients (56.7% males; mean age: 60.2 ± 13 years) were retrospectively evaluated. The data collected included technical and clinical success, adverse events and follow-up findings (1, 3 and 6 months).

RESULTS

Technical and clinical success rates were 100%. One early mild post-procedure pancreatitis occurred and resolved spontaneously. Three late stent distal migrations occurred, however cholangiography showed correct leak sealing in all patients. Stents were removed after a mean of 55.9 days. During follow-up no other complications occurred.

CONCLUSION

In our experience fully covered self-expanding metal stent placement was safe and efficacious as first-step therapy for post-operative biliary leaks. However, prospective comparative studies with plastic stents are required to validate these findings.

A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP

BACKGROUND

Fully covered self-expandable metal stents (FCSEMSs) have been used for palliation of both malignant and benign biliary strictures. Limited data are available about safety and outcome of endoscopic removal of these stents.

OBJECTIVE

To evaluate safety and efficacy of endoscopic removal of FCSEMSs.

DESIGN

Retrospective review of patients who underwent endoscopic removal of Viabil FCSEMSs.

SETTING

Four centers with experience in using FCSEMSs.

PATIENTS

Thirty-seven patients who had stents endoscopically removed.

INTERVENTION

ERCP with endoscopic removal of FCSEMSs.

MAIN OUTCOME MEASUREMENTS

Feasibility, safety, and complications associated with endoscopic removal of FCSEMS.

RESULTS

All 37 stent removal attempts were successful and were achieved without difficulty. Indwelling stent-related complications occurred in 4 of 37 patients, including secondary strictures in 3 and minor bile leak in 1. Two of 3 secondary strictures occurred at the distal stent margin of oversized intraductal stents, and another stricture occurred at a proximal stent margin of an oversized transpapillary stent. One case of minor confined intratumoral bile leak also occurred in a patient with metastatic urothelial cancer of the bile duct. All of these cases were successfully treated with repeat stenting and resolved without sequelae. No free perforations or significant bleeding occurred.

LIMITATIONS

Retrospective study.

CONCLUSION

Endoscopic removal of Viabil FCSEMSs placed for benign or malignant conditions is feasible and easily accomplished. Secondary strictures may be found at the time of stent removal or with a delayed presentation in patients with oversized stents who may require repeat stent placement.