Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video)
| Autor: | Andrew Brock, Jeffrey L. Tokar, Michel Kahaleh, Brian W. Behm, Sarah A. De La Rue, Vinay Sundaram, Paul Yeaton, Vanessa M. Shami, Reid B. Adams, Bridger W. Clarke |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Forceps Pilot Projects Single Center Primary sclerosing cholangitis Cohort Studies Prosthesis Implantation Coated Materials Biocompatible medicine Humans Radiology Nuclear Medicine and imaging Device Removal Aged Autoimmune pancreatitis Aged 80 and over Cholestasis medicine.diagnostic_test business.industry Gastroenterology Stent Equipment Design Middle Aged Bleed medicine.disease Surgery Treatment Outcome Metals Pancreatitis Female Stents business Liver function tests |
| Zdroj: | Gastrointestinal Endoscopy. 67:446-454 |
| ISSN: | 0016-5107 |
| Popis: | Background Benign biliary strictures (BBS) are usually managed with plastic stents, whereas placement of uncovered metallic stents has been associated with failure related to mucosal hyperplasia. Objective We analyzed the efficacy and safety of temporary placement of a covered self-expanding metal stent (CSEMS) in BBS. Design Patients with BBS received temporary placement of CSEMSs until adequate drainage was achieved; confirmed by resolution of symptoms, normalization of liver function tests, and imaging. Setting Tertiary-care center with long-standing experience with CSEMSs. Patients Seventy-nine patients with BBS secondary to chronic pancreatitis (32), calculi (24), liver transplant (16), postoperative biliary repair (3), autoimmune pancreatitis (3), and primary sclerosing cholangitis (1). Intervention ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or a rat-tooth forceps. Main Outcome Measurements End points were efficacy, morbidity, and clinical response. Results CSEMSs were removed from 65 patients. Resolution of the BBS was confirmed in 59 of 65 patients (90%) after a median follow-up of 12 months after removal (range 3-26 months). If patients who were lost to follow-up, developed cancer, or expired were considered failures, then an intent-to-treat global success rate of 59 of 79 (75%) was obtained. Complications associated with placement included 3 post-ERCP pancreatitis (4%), 1 postsphincterotomy bleed (1%), and 2 pain that required CSEMS removal (2%). In 11 patients (14%), the CSEMS migrated. In 1 patient, CSEMS removal was complicated by a bile leak that was successfully managed with plastic stents. Limitation Pilot study from a single center. Conclusions Temporary CSEMS placement in patients with BBS offers a potential alternative to surgery. |
| Databáze: | OpenAIRE |
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