Removable metal stents in treating perioperative refractory biliary hemorrhage patients with cirrhosis and common bile duct stone

Abstract

Endoscopic retrograde cholangiopancreatonraphy (ERCP) is the main treatment modality for common bile duct stone. Biliary hemorrhage easily occurred in patients suffe-ring from cirrhosis during and after ERCP. From May 2012 to May 2016, 8 cases diagnosed with cirrhosis and common bile duct stones who developed post-ERCP refractory biliary hemorrhage were treated with full-covered self-expanding removable metal stents (FCSERMS), including 5 cases with perioperative hemorrhage of ERCP and 3 cases with delayed onset of biliary hemorrhage post ERCP. All the patients were successfully implanted with FCSERMS. Seven patients had successful hemostasis, and the other one case with ineffective hemostasis was treated with interventional arterial embolization later. Four stents were removed within 4 weeks and one in 8 months after ERCP. No evidence of biliary hemorrhage, intestinal fistula and other complications was observed during removal procedures. Spontaneous stent dislodgment occurred in one patient in postoperative 4 weeks, one patient died of liver failure in postoperative 6 months and one patient carried FCSERMS for 23 months. Key words: Endoscopic retrograde cholangiopancreatonraphy; Endoscopic sphincterotomy; Common bile duct stones; Biliary hemorrhage; Removable metal stent; Cirrhosis