BACKGROUND: Complex biliary stones often require temporary stent placement before a repeat attempt at extraction. To date, covered self-expandable metal stents (CSEMSs) have not been formally investigated for this indication. OBJECTIVE: To evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones. DESIGN: Retrospective case series. SETTING: Large quaternary-care center. PATIENTS: Thirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy. INTERVENTIONS: Patients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction. MAIN OUTCOME MEASUREMENTS: Success achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed. RESULTS: CSEMS placement was successful in establishing immediate biliary drainage in all 36 patients. Complete duct clearance at repeat ERC was achieved in 29 of 35 patients after a mean duration of 6.4 weeks. Four of the remaining 6 patients underwent sequential CSEMS placement, with eventual duct clearance after multiple ERCPs. There were no complications related to biliary obstruction. One patient died of a nonbiliary cause. Of the total 42 CSEMSs placed, there were 4 cases (9.5%) of clinically insignificant stent migration. LIMITATIONS: Single-center experience, retrospective design. CONCLUSIONS: CSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.
BACKGROUND: Complex biliary stones often require temporary stent placement before a repeat attempt at extraction. To date, covered self-expandable metal stents (CSEMSs) have not been formally investigated for this indication. OBJECTIVE: To evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones. DESIGN: Retrospective case series. SETTING: Large quaternary-care center. PATIENTS: Thirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy. INTERVENTIONS:Patients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction. MAIN OUTCOME MEASUREMENTS: Success achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed. RESULTS: CSEMS placement was successful in establishing immediate biliary drainage in all 36 patients. Complete duct clearance at repeat ERC was achieved in 29 of 35 patients after a mean duration of 6.4 weeks. Four of the remaining 6 patients underwent sequential CSEMS placement, with eventual duct clearance after multiple ERCPs. There were no complications related to biliary obstruction. One patient died of a nonbiliary cause. Of the total 42 CSEMSs placed, there were 4 cases (9.5%) of clinically insignificant stent migration. LIMITATIONS: Single-center experience, retrospective design. CONCLUSIONS: CSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.
Authors: Giuseppe Grande; Paolo Cecinato; Angelo Caruso; Helga Bertani; Francesco Paolo Zito; Romano Sassatelli; Rita Conigliaro Journal: Turk J Gastroenterol Date: 2019-03 Impact factor: 1.852