Abstract
Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Methods. All consecutive patients with benign biliary strictures were treated with placement of a fully covered SEMS (WallFlex) for 6 months. Short- and long-term stricture resolution, adverse events, and ease of stent removal were recorded. Results. 23 patients were enrolled. Stricture etiology was chronic pancreatitis (14), postorthotopic liver transplant (4), idiopathic (4), and biliary stones (1). All ERCPs were technically successful. All stents were successfully removed. Short-term stricture resolution was seen in 22/23 (96%) patients. Long-term success was 15/18 (83.3%). All 3 failures were patients with biliary strictures in the setting of chronic calcific pancreatitis. Conclusions. The use of the new SEMS for the treatment of benign biliary strictures led to short-term stricture resolution in the vast majority of patients. Over a long-term followup the success rate appears favorable compared to historical results achieved with multiple plastic stenting, particularly in patients with chronic pancreatitis. The study was registered with ClinicalTrials.gov (NCT01238900).
Highlights
IntroductionThe two leading etiologies are chronic pancreatitis (CP) and postoperative complications, either related to bile duct injury at the time of cholecystectomy or anastomotic narrowing after orthotopic liver transplantation (OLT)
Benign biliary strictures are common and challenging clinical problems
Consecutive patients referred to the University of Florida for endoscopic retrograde cholangiopancreatography (ERCP) for benign biliary strictures were considered for study enrollment from July 2009 to December 2011
Summary
The two leading etiologies are chronic pancreatitis (CP) and postoperative complications, either related to bile duct injury at the time of cholecystectomy or anastomotic narrowing after orthotopic liver transplantation (OLT). In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Short- and long-term stricture resolution, adverse events, and ease of stent removal were recorded. The use of the new SEMS for the treatment of benign biliary strictures led to short-term stricture resolution in the vast majority of patients. Over a long-term followup the success rate appears favorable compared to historical results achieved with multiple plastic stenting, in patients with chronic pancreatitis.
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