Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos) - 27/08/11
Reprint requests: Michel Kahaleh, MD, FASGE, Chief of Advanced Endoscopy, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021Résumé |
Background |
Complex biliary stones often require temporary stent placement before a repeat attempt at extraction. To date, covered self-expandable metal stents (CSEMSs) have not been formally investigated for this indication.
Objective |
To evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones.
Design |
Retrospective case series.
Setting |
Large quaternary-care center.
Patients |
Thirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy.
Interventions |
Patients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction.
Main Outcome Measurements |
Success achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed.
Results |
CSEMS placement was successful in establishing immediate biliary drainage in all 36 patients. Complete duct clearance at repeat ERC was achieved in 29 of 35 patients after a mean duration of 6.4 weeks. Four of the remaining 6 patients underwent sequential CSEMS placement, with eventual duct clearance after multiple ERCPs. There were no complications related to biliary obstruction. One patient died of a nonbiliary cause. Of the total 42 CSEMSs placed, there were 4 cases (9.5%) of clinically insignificant stent migration.
Limitations |
Single-center experience, retrospective design.
Conclusions |
CSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.
Le texte complet de cet article est disponible en PDF.Abbreviations : CHD, CSEMS, EPBD, ERC
Plan
| DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr. Kahaleh: research grants from Boston Scientific, Pentax, Fuji, MI Tech; consultant to Xlumina. The other authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr. Kahaleh at mkahaleh@gmail.com. |
Vol 74 - N° 3
P. 520-526 - septembre 2011 Retour au numéro
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