Background and aim: The standard treatment of biliary stones removal requires endoscopic retrograde cholangiopancreatography (ERCP) plus biliary sphincterotomy (EBS) and in patients with the impossibility to perform EBS, balloon papillary dilation (BPD) could be an attractive alternative. The number of patients with antiplatelets therapy is increasing in the last years, the U.S.A. rate of aspirin use among patients with diabetes was estimated at 48.7% for individuals with cardiovascular disease (CVD). A percentage of them, despite low, cannot suspend the therapy. Material and methods: A 76-year-old man, undergone aorto-choronarich by-pass, with a recurrent episode of myocardial infarction despite the dual antiplatelets therapy, was sent to our center for a radiological diagnosis of a biliary stone of 15 mm length of the third middle common bile duct (CBD), conditioning cholangitis. Cardiologists and haematologists were not agree on stopping antiplatelets therapy or replacing it with heparin or other window drugs. Results: The patient underwent ERCP 7 days before, without EBS, with placement of a right plastic stent to solve the cholangitis, by-passing the stone, migrated on day 3rd after procedure. The patient underwent newly ERCP and for the impossibility of performing an EBS a covered removable self-expandable metal stent with anchoring flap (CRSEMS-AF) (Hanarostent- M.I.Tech Co.; Seoul; South Corea) 6cm length and 10mm large was deployed across the Vater’s papilla. With an extraction balloon the sones was placed inside the CREMS-AF, and, removing the CRSEMS-AF from the distal lasso, we removed the stent with the sone inside. The successive cholangiography showed no other stones in the CBD. Conclusions: In patient with not suspendable dual antiplatelets therapy, the use of CRSEMS-AF for stone extraction may be an expensive but alternative procedure to others. Moreover, the anchoring flaps of the CRSEMS-AF enabled us to avoid the distal migration of the stent during the placement of the stones inside the stent itself with the extraction balloon.
Covered removable self-expandable “anchoring-flap” metal stent for biliary stone extraction in a patient with dual antiplatelets therapy agents (with video).
Mangiavillano B;
2014-01-01
Abstract
Background and aim: The standard treatment of biliary stones removal requires endoscopic retrograde cholangiopancreatography (ERCP) plus biliary sphincterotomy (EBS) and in patients with the impossibility to perform EBS, balloon papillary dilation (BPD) could be an attractive alternative. The number of patients with antiplatelets therapy is increasing in the last years, the U.S.A. rate of aspirin use among patients with diabetes was estimated at 48.7% for individuals with cardiovascular disease (CVD). A percentage of them, despite low, cannot suspend the therapy. Material and methods: A 76-year-old man, undergone aorto-choronarich by-pass, with a recurrent episode of myocardial infarction despite the dual antiplatelets therapy, was sent to our center for a radiological diagnosis of a biliary stone of 15 mm length of the third middle common bile duct (CBD), conditioning cholangitis. Cardiologists and haematologists were not agree on stopping antiplatelets therapy or replacing it with heparin or other window drugs. Results: The patient underwent ERCP 7 days before, without EBS, with placement of a right plastic stent to solve the cholangitis, by-passing the stone, migrated on day 3rd after procedure. The patient underwent newly ERCP and for the impossibility of performing an EBS a covered removable self-expandable metal stent with anchoring flap (CRSEMS-AF) (Hanarostent- M.I.Tech Co.; Seoul; South Corea) 6cm length and 10mm large was deployed across the Vater’s papilla. With an extraction balloon the sones was placed inside the CREMS-AF, and, removing the CRSEMS-AF from the distal lasso, we removed the stent with the sone inside. The successive cholangiography showed no other stones in the CBD. Conclusions: In patient with not suspendable dual antiplatelets therapy, the use of CRSEMS-AF for stone extraction may be an expensive but alternative procedure to others. Moreover, the anchoring flaps of the CRSEMS-AF enabled us to avoid the distal migration of the stent during the placement of the stones inside the stent itself with the extraction balloon.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
