Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: Time to revisit our therapeutic options?

Michel Kahaleh, Alan Brijbassie, Amrita Sethi, Marisa Degaetani, John M. Poneros, David E. Loren, Thomas E. Kowalski, Divyesh V. Sejpal, Sandeep Patel, Laura Rosenkranz, Kevin N. McNamara, Isaac Raijman, Jayant P. Talreja, Monica Gaidhane, Bryan G. Sauer, Peter D. Stevens

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Abstract

BACKGROUND: Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS. AIM: To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS. PATIENTS AND METHODS: Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications. RESULTS: A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as follows: postsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)]. CONCLUSIONS: FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.

Original languageEnglish (US)
Pages (from-to)695-699
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume47
Issue number8
DOIs
Publication statusPublished - Sep 1 2013

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Keywords

  • Benign biliary stricture
  • FCSEMS
  • Fully covered self-expanding metal stent
  • Metal stent

ASJC Scopus subject areas

  • Gastroenterology

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