Metal Stents For Biliary Strictures Research Articles

Use of washing cytology from removed self-expandable metal stents for biliary strictures: a novel cytology method.

Removability is one of the important features of biliary covered self-expandable metal stents (CSEMS). In this study, we evaluated the diagnostic ability of washing cytology of removed CSEMS. For 14 removed CSEMS that had been placed for the biliary strictures (12 malignant, 2 benign), the surface of CSEMS was washed with saline, and pathological examination of the washing liquid as cytology (CSEMS washing cytology) was performed. The specimen sampling rates and sensitivity for malignancy of CSEMS washing cytology were 92.9 % and 41.7 %, respectively. Sensitivity according to the primary disease was 60.0 % for bile duct cancer and 20 % for pancreatic cancer. Sensitivities based on the methods of stent removal were 16.7 % and 66.7 % for removal through the channel of the scope and with the scope, respectively. Therefore, it is possible that sensitivity of CSEMS washing cytology is higher in bile duct cancer and for removal with the scope. In conclusion, CSEMS washing cytology may have potential as a pathological diagnostic method.

Tu1499 Use of a Double-Pigtail Stent to Prevent Migration of Fully Covered Metal Stents in Biliary Strictures: A Retrospective Analysis

Migration has been reported in up to 37.5% of patients with fully-covered self-expandable metal stent (FCSEMS). Placement of plastic double pigtail stents within FCSEMS may decrease migration. In this study, we aim to compare stent migration rates in patients with biliary strictures who receive FCSEMS alone to those who receive both a FCSEMS and an anchoring plastic stent (PS).

ROLE OF ENDOSCOPIC STENTING FOR BILIARY STRICTURES IN CHRONIC PANCREATITIS

To review the published work concerning the role of biliary stenting for chronic pancreatitis-related strictures. A case study in which multiple plastic stents are used to manage a chronic pancreatitis biliary stricture is presented, and the published work reviewed. There has been a gradual evolution in the endoscopic management of distal biliary strictures secondary to chronic pancreatitis. Most early series used single (usually 10 F) plastic stents for varying time periods. Long-term stricture resolution occurred in only approximately 25% of patients and stent-related complications were high if stent exchanges were not performed routinely every 3-4 months. Recent studies using multiple (≥ 3) 10 F stents placed sequentially every few months for approximately 12 months have resulted in resolution of biliary strictures in up to 90% of patients. In general, the use of both uncovered and partially covered self-expandable metal stents for biliary strictures due to chronic pancreatitis have been disappointing due to problems with epithelial hyperplasia involving the uncovered portions of the self-expandable metal stents resulting in late stent occlusion and other problems. Similarly, early published data does not at this stage support the routine use of fully covered self-expandable metal stents because of unacceptable stent-related complications. Chronic pancreatitis-related biliary strictures should be managed initially with sequentially-placed multiple 10 F plastic stents for approximately 12 months.

Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting: a prospective study with 2 years of follow-up

Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting: a prospective study with 2 years of follow-up

Endoscopic Placement of Expandable Metal Stents for Biliary Strictures - A Preliminary Report on Experience with 33 Patients

The main problem with palliative treatment of extrahepatic cholestasis with an endoscopic biliary endoprosthesis is clogging. One of the factors thought to be of importance is the diameter of the stent. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. In this article we report on our preliminary clinical experience with an endoscopically placed expandable metal stent ("Wallstent") in 33 patients with extrahepatic bile duct stenoses. When fully expanded, the stent has a diameter of 30 F and a length of 6.7 cm. It was possible to successfully place a stent in every patient. Clinical improvement was achieved in all patients except one. Two patients underwent elective surgery, while one died of renal failure. Another died of septic shock after 5 weeks, but no autopsy was performed. In conclusion, our initial experience with this stent shows that at least in the short term biliary drainage was excellent, with no complications of pancreatitis or hemorrhage. Longer follow-up than our 4 weeks is necessary to establish the position of this stent in comparison with the conventional endoprosthesis in the management of obstructive jaundice.