4:02 PM Abstract No. 107 - Outcomes of viabil covered stent placement for treatment of hepaticojejunostomy strictures

Abstract

Purpose Viabil ePTFE/FEP-covered biliary stents have shown excellent patency and reported migration rates of 0.3% based on early clinical studies in patients with malignant biliary strictures. Strictures at surgical hepaticojejunostomy sites present a particular challenge because of the short landing zone within the duct. The purpose of this study is to assess outcomes of Viabil stent placement for hepaticojejunostomy strictures. Materials and Methods We retrospectively reviewed our records for Viabil stent placement procedures performed between Feb. 2006 and Sept. 2012 and included in this study patients who had undergone Viabil placement to treat hepaticojejunostomy strictures. The cause of stricture and follow-up clinical and radiographic data were collected. Results Of a total of 90 Viabil placement procedures in 88 patients, 13 patients underwent 14 interventions in which a Viabil stent was deployed across a hepaticojejunostomy for malignant (n=12) and benign (n=1) biliary strictures. The following sizes were used: 8×4 (n=5), 8×6 (n=6), 10×6 (n=4), 10×8 (n=1), and 10×10 (n=1) (mm diameter × cm length). One patient underwent stent placement in a double-barrel configuration, and another underwent stent placement in a Y configuration. During followup (mean 115 d, range 0-404 d), three stents (21% of placements), all 8x4 size, migrated: one on the day of placement and two detected 200 and 340 days later. There were no complications from stent passage. Three patients required reintervention for occluded 10 mm stents (21% of placements): One with benign stricture underwent stent removal (381 d), and two underwent biliary drain placement (137 and 155 d). One of the stent occlusion patients had Viabil stents placed in a Y configuration. Conclusion Viabil placement for hepaticojejunostomy strictures is technically feasible but is associated with higher rates of stent migration (21%) than described in the literature. As the migrated stents were only 4 cm long, use of longer fenestrated stents, with greater apposition to the hepatic ducts, may be helpful to avoid that complication.