Payal Saxena1,2, David L Diehl3, Vivek Kumbhari4, Frederick Shieh3, Jonathan M Buscaglia5, Wilson Sze5, Sumit Kapoor5, Srinadh Komanduri6, John Nasr7, Eun Ji Shin4, Vikesh Singh4, Anne Marie Lennon4, Anthony N Kalloo4, Mouen A Khashab4,8. 1. Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. psaxena1@jhmi.edu. 2. Lifehouse at Royal Prince Alfred Hospital, 119 Missenden Rd, Campberdown, NSW, 2050, Australia. psaxena1@jhmi.edu. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Geisinger Health System, Danville, PA, USA. 4. Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. 5. Division of Gastroenterology and Hepatology, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA. 6. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA. 7. Division of Gastroenterology and Hepatology, Department of Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA. 8. Johns Hopkins Hospital, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA.
Abstract
BACKGROUND: Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges. AIMS: The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS. METHODS: A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded. RESULTS: A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57% were males. Stricture resolution occurred in 81% of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7%) was the most common complication, followed by stent occlusion (4.9%), cholangitis (4.1%), and pancreatitis (3.3%). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis. CONCLUSIONS: Majority of BBS can be successfully managed with 1-2 consecutive FCSEMS with stent dwell time of 6 months.
BACKGROUND: Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges. AIMS: The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS. METHODS: A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded. RESULTS: A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57% were males. Stricture resolution occurred in 81% of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7%) was the most common complication, followed by stent occlusion (4.9%), cholangitis (4.1%), and pancreatitis (3.3%). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis. CONCLUSIONS: Majority of BBS can be successfully managed with 1-2 consecutive FCSEMS with stent dwell time of 6 months.
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