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Efficacy of a modified short fully covered self-expandable metal stent for perihilar benign biliary strictures.
- Source :
-
Journal of gastroenterology and hepatology [J Gastroenterol Hepatol] 2021 Apr; Vol. 36 (4), pp. 1057-1063. Date of Electronic Publication: 2020 Sep 23. - Publication Year :
- 2021
-
Abstract
- Background and Aim: Endoscopic management of a benign biliary stricture (BBS) on the hilum is complicated and challenging. Although the placement of a fully covered self-expandable metal stent (FCSEMS) is possible to increase effectiveness, stent migration and stent-induced adverse events are problematic. We aimed to evaluate the usefulness of a modified short FCSEMS with a long lasso in patients with a difficult perihilar BBS.<br />Methods: Patients with perihilar BBS within 2 cm from the hilar confluence that failed initially with plastic stents were enrolled. A modified short FCSEMS was deployed and then removed 5-6 months later. The primary outcome was clinical success. Other technical success, adverse events, endoscopic success of stent removal, and recurrence of stricture during the follow-up period were measured.<br />Results: Endoscopic intraductal placement was technically successful in all patients (n = 19). Combined contralateral plastic stent placement was performed in 13 patients (68.4%). The median duration of stent placement was 163 days (range, 138-196 days). Endoscopic stent removal was successful in all patients except one spontaneous distal migration. Stricture resolution without de novo focal stricture occurrence was 100%. Endoscopic stone removal after stricture improvement was successful in all 13 patients with bile duct stones above the stricture. During a follow-up period (median 635 days) after stent removal, only one recurrence developed.<br />Conclusions: Temporary placement of a modified intraductal short FCSEMS with or without a contralateral plastic stent improved perihilar BBS in patients that primarily failed by plastic stents. Combined biliary stones were also successfully removed after stricture resolution.<br /> (© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
- Subjects :
- Bile Ducts pathology
Constriction, Pathologic
Device Removal
Endoscopy, Digestive System methods
Female
Follow-Up Studies
Humans
Male
Plastics adverse effects
Recurrence
Treatment Failure
Treatment Outcome
Bile Ducts surgery
Biliary Tract Surgical Procedures methods
Self Expandable Metallic Stents adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1440-1746
- Volume :
- 36
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of gastroenterology and hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 32926577
- Full Text :
- https://doi.org/10.1111/jgh.15258