Background and aim: Management of the benign biliary disease (BBD), as the benign strictures (BS) and the biliary leak (BL), includes ERCP with nosebiliary drainage or one or more than one plastic stent placement. When this treatment fails the current available option remains surgery. Covered removable self expandable metal stents (CRSEMS) offer an attractive option for the treatment of this patients but the risk of distal migration has been reported till 37.5%. The aim of our study was to assess the use of CRSEMS with a new anti-migration system (CRSEMS-AF) in the benign biliary pathology, for preventing the distal migration. Material and methods: 30 consecutive patients (10 F and 20 M; mean age: 61.7±15.3) with a BBD suitable of a CRSEMS treatment underwent CRSEMS-AF placement. We had 22 BS (10 post-EBS; 4 post-VLC; 2 post-ab extrinsic compression; 2 chronic pancreatitis; 2 PSC; 1 post-OLT; 1 post-scar) and 8 BL (6 after VLC and 2 after OC) (5 cystic duct; 2 middle III CBD and 1 proximal CBD). Of the 22 BS: 14 were in the CBD distal III; 3 in the CBD middle III and 5 in the CBD proximal III. Results: Mean strictures’ length was of 2.1±1 cm.We had a technical success of 100% and an immediate clinical success (at 72 hours after CRSEMS-AF placement) of 96.7%. We had one immediate complication (3.3%), a bilioportal fistula after stent release solved spontaneously in a cirrhotic patient. In 22 patients the stent was removed and the CRSEMS-AF were left in place for a mean of 97.3±69.1 days (range: 4–230 days). We had a death not stent-related at 122 days. No strictures or leaks were observed at the cholangiography after CRSEMS-AF removal in the 22 patients. We had no CRSEMS-AF migration (0/23 patients; 0%). One patient, after removal of CRSEMS-AF placed for post-EBS stricture, was biopsied and histology diagnosed a cholangiocarcinoma: the patient underwent DCP and excluded from the data analysis. Of the 23 BBD solved 18 were BS and 5 were leaks (including the death). The CRSEMS-AF used were 4 of 10 cm; 7 of 8cm; 6 of 7cm; 9 of 6cm; 3 of 5cm and 1 of 4cm length. Conclusions: CRSEMS represent an attractive good option in patients with benign biliary pathology not suitable to the conventional endoscopic treatment and CRSEMS-AF cancels the distal migration rate.
Covered removable self-expandable metal stents with the new “anchoring-flap system” for the treatment of benign biliary disease reduce distal migration
Mangiavillano B;
2013-01-01
Abstract
Background and aim: Management of the benign biliary disease (BBD), as the benign strictures (BS) and the biliary leak (BL), includes ERCP with nosebiliary drainage or one or more than one plastic stent placement. When this treatment fails the current available option remains surgery. Covered removable self expandable metal stents (CRSEMS) offer an attractive option for the treatment of this patients but the risk of distal migration has been reported till 37.5%. The aim of our study was to assess the use of CRSEMS with a new anti-migration system (CRSEMS-AF) in the benign biliary pathology, for preventing the distal migration. Material and methods: 30 consecutive patients (10 F and 20 M; mean age: 61.7±15.3) with a BBD suitable of a CRSEMS treatment underwent CRSEMS-AF placement. We had 22 BS (10 post-EBS; 4 post-VLC; 2 post-ab extrinsic compression; 2 chronic pancreatitis; 2 PSC; 1 post-OLT; 1 post-scar) and 8 BL (6 after VLC and 2 after OC) (5 cystic duct; 2 middle III CBD and 1 proximal CBD). Of the 22 BS: 14 were in the CBD distal III; 3 in the CBD middle III and 5 in the CBD proximal III. Results: Mean strictures’ length was of 2.1±1 cm.We had a technical success of 100% and an immediate clinical success (at 72 hours after CRSEMS-AF placement) of 96.7%. We had one immediate complication (3.3%), a bilioportal fistula after stent release solved spontaneously in a cirrhotic patient. In 22 patients the stent was removed and the CRSEMS-AF were left in place for a mean of 97.3±69.1 days (range: 4–230 days). We had a death not stent-related at 122 days. No strictures or leaks were observed at the cholangiography after CRSEMS-AF removal in the 22 patients. We had no CRSEMS-AF migration (0/23 patients; 0%). One patient, after removal of CRSEMS-AF placed for post-EBS stricture, was biopsied and histology diagnosed a cholangiocarcinoma: the patient underwent DCP and excluded from the data analysis. Of the 23 BBD solved 18 were BS and 5 were leaks (including the death). The CRSEMS-AF used were 4 of 10 cm; 7 of 8cm; 6 of 7cm; 9 of 6cm; 3 of 5cm and 1 of 4cm length. Conclusions: CRSEMS represent an attractive good option in patients with benign biliary pathology not suitable to the conventional endoscopic treatment and CRSEMS-AF cancels the distal migration rate.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
