Fully-covered removable self-expandable metal stents as first-step therapy for the treatment of biliary leaks

Background and aim: Fully covered, self-expanding metal stents (FCSEMS) are now being used to treat biliary tract injuries after surgery. The aim of the study was to assess the safety and effectiveness of biliary FCSEMS placement as first-step endoscopic treatment in patients with biliary leaks secondary to hepato-biliary surgery. Material and methods: Between January 2010 and December 2011, 30 consecutive patients (17 males; mean age 60 years) with biliary leaks were enrolled. Results: The technical and clinical success rate was 100%, with absence ofbile flow in the external drain after a mean of 1.3 days. One early complication occurred: a mild post-procedure pancreatitis, which resolved spontaneously. The patients were discharged a mean of 4.1 days after FCSEMS placement. Three cases of late stent distal migration occurred and were found at endoscopic retrograde cholangiopancreatography performed for stent removal, however cholangiography showed in all these three patients a correct seal of the leak. The FCESMS that were removed remained in place for a mean of 55.9 days. The long term clinical outcome was positive in 100% of the patients evaluated at 1, 3 and 6 months after stent removal. Conclusions: FCSEMS could be a good option as first-step endoscopic therapy for the treatment of post-operative biliary leaks.