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Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos).

Abstract：

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Cerefice M,Sauer B,Javaid M,Smith LA,Gosain S,Argo CK,Kahaleh M

doi

10.1016/j.gie.2011.05.026

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

520-6

issue

3

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(11)01701-9

journal_volume

74

pub_type

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