Evaluation of the Feasibility and Effectiveness of Placement of Fully Covered Self-Expandable Metallic Stents via Various Insertion Routes for Benign Biliary Strictures.
benign biliary stricture
biliary stent
endoscopic treatment
fully covered self-expandable metallic stents
metal stent
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
28 May 2021
28 May 2021
Historique:
received:
22
04
2021
revised:
17
05
2021
accepted:
28
05
2021
entrez:
2
6
2021
pubmed:
3
6
2021
medline:
3
6
2021
Statut:
epublish
Résumé
The goals of the management of benign biliary stricture (BBS) are to relieve symptoms and resolve short-/long-term stricture. We performed fully covered self-expandable metallic stent (hereafter, FCSEMS) placement for BBS using various methods and investigated the treatment outcomes and adverse events (AEs). We retrospectively studied patients who underwent FCSEMS placement for refractory BBS through various approaches between January 2017 and February 2020. FCSEMS were placed for 6 months, and an additional FCSEMS was placed if the stricture had not improved. Technical success rate, stricture resolution rate, and AE were measured. A total of 26 patients with BBSs that were difficult to manage with plastic stents were included. The mean overall follow-up period was 43.3 ± 30.7 months. The cause of stricture was postoperative (46%), inflammatory (31%), and chronic pancreatitis (23%). There were four insertion methods: endoscopic with duodenoscopy, with enteroscopy, EUS-guided transmural, and percutaneous transhepatic. The technical success rate was 100%, without any AE. Stricture resolution was obtained in 19 (83%) of 23 cases, except for three cases of death due to other causes. Stent migration and cholangitis occurred in 23% and 6.3%, respectively. Stent fracture occurred in two cases in which FCSEMSs were placed for more than 6 months (7.2 and 10.3 months). FCSEMS placement for refractory BBS via various insertion routes was feasible and effective. FCSEMSs should be exchanged every 6 months until stricture resolution because of stent durability. Further prospective study for confirmation is required, particularly regarding EUS-guided FCSEMS placement.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
The goals of the management of benign biliary stricture (BBS) are to relieve symptoms and resolve short-/long-term stricture. We performed fully covered self-expandable metallic stent (hereafter, FCSEMS) placement for BBS using various methods and investigated the treatment outcomes and adverse events (AEs).
METHODS
METHODS
We retrospectively studied patients who underwent FCSEMS placement for refractory BBS through various approaches between January 2017 and February 2020. FCSEMS were placed for 6 months, and an additional FCSEMS was placed if the stricture had not improved. Technical success rate, stricture resolution rate, and AE were measured.
RESULTS
RESULTS
A total of 26 patients with BBSs that were difficult to manage with plastic stents were included. The mean overall follow-up period was 43.3 ± 30.7 months. The cause of stricture was postoperative (46%), inflammatory (31%), and chronic pancreatitis (23%). There were four insertion methods: endoscopic with duodenoscopy, with enteroscopy, EUS-guided transmural, and percutaneous transhepatic. The technical success rate was 100%, without any AE. Stricture resolution was obtained in 19 (83%) of 23 cases, except for three cases of death due to other causes. Stent migration and cholangitis occurred in 23% and 6.3%, respectively. Stent fracture occurred in two cases in which FCSEMSs were placed for more than 6 months (7.2 and 10.3 months).
CONCLUSION
CONCLUSIONS
FCSEMS placement for refractory BBS via various insertion routes was feasible and effective. FCSEMSs should be exchanged every 6 months until stricture resolution because of stent durability. Further prospective study for confirmation is required, particularly regarding EUS-guided FCSEMS placement.
Identifiants
pubmed: 34071678
pii: jcm10112397
doi: 10.3390/jcm10112397
pmc: PMC8198386
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Gastrointest Endosc. 2002 May;55(6):680-6
pubmed: 11979250
Endoscopy. 2021 Jun;53(6):E201-E202
pubmed: 32916725
Gastrointest Endosc. 2001 Aug;54(2):162-8
pubmed: 11474384
Gastrointest Endosc. 2012 May;75(5):1080-5
pubmed: 22401821
Gastrointest Endosc. 2009 Aug;70(2):303-9
pubmed: 19523620
Gastrointest Endosc. 2015 Jul;82(1):9-19
pubmed: 25922248
Endoscopy. 2017 Jan;49(1):75-79
pubmed: 27997964
Gastrointest Endosc. 2015 May;81(5):1197-203
pubmed: 25660982
Gastrointest Endosc Clin N Am. 2013 Oct;23(4):833-45
pubmed: 24079793
Gastrointest Endosc. 2020 Feb;91(2):361-369.e3
pubmed: 31494135
Gastrointest Endosc. 2019 Feb;89(2):399-407
pubmed: 30076841
JAMA. 2016 Mar 22-29;315(12):1250-7
pubmed: 27002446
Endoscopy. 2016 May;48(5):440-7
pubmed: 26919262
Endoscopy. 2012 Mar;44(3):246-50
pubmed: 22354824
Endoscopy. 2012 May;44(5):536-8
pubmed: 22370701
J Gastroenterol Hepatol. 2020 Mar;35(3):492-498
pubmed: 31418477
J Gastroenterol Hepatol. 2021 Apr;36(4):1057-1063
pubmed: 32926577
Endoscopy. 2015 Jul;47(7):605-10
pubmed: 25590182
J Vasc Interv Radiol. 2016 Feb;27(2):219-225.e1
pubmed: 26710970
Gastrointest Endosc. 2011 Oct;74(4):916-20
pubmed: 21821252
Endoscopy. 2020 May;52(5):368-376
pubmed: 32092770
Dig Endosc. 2015 Jan;27(2):259-64
pubmed: 25209944
Endoscopy. 2018 Sep;50(9):910-930
pubmed: 30086596