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Management of benign biliary strictures with fully covered self-expanding metal stents

August's issue of Gastroenterology investigates the ability to remove these stents after extended indwell and the frequency and durability of stricture resolution.

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Fully covered self-expanding metal stents are gaining acceptance for the treatment of benign biliary strictures.

Dr Jacques Devière and colleagues performed a large prospective multinational study to evaluate the ability to remove these stents after extended indwell and the frequency and durability of stricture resolution.

In a nonrandomized study at 13 centers in 11 countries, 187 patients with benign biliary strictures received fully covered self-expanding metal stents.

Removal was scheduled at 10–12 months for patients with chronic pancreatitis or cholecystectomy, and at 4–6 months for patients who received liver transplants.

The team's primary outcome measure was removal success, defined as either scheduled endoscopic removal of the stent with no removal-related serious adverse events or spontaneous stent passage without the need for immediate restenting.

Removal success was accomplished in 75%
Gastroenterology

Endoscopic removal of fully covered self-expanding metal stents was not performed for 10 patients because of death, withdrawal of consent, or switch to palliative treatment.

The research team noted that for the remaining 177 patients, removal success was accomplished in 75%.

Removal success was more frequent in the chronic pancreatitis group than in the liver transplantation or cholecystectomy groups.

The team noted that fully covered self-expanding metal stents were removed by endoscopy from all patients in whom this procedure was attempted.

Stricture resolution without restenting upon fully covered self-expanding metal stents removal occurred in 76% of patients.

The researchers found that the rate of resolution was lower in patients with FCSEMS migration.

Over a median follow-up period of 20 months, the team noted that the rate of stricture recurrence was 15%.

Stent- or removal-related serious adverse events, most often cholangitis, occurred in 27% of patients.

The team observed no stent- or removal-related mortality.

Dr Devière's team concludes, "In a large prospective multinational study, removal success of fully covered self-expanding metal stents after extended indwell and stricture resolution were achieved for approximately 75% of patients."

Gastroenterology 2014: 147(2): 385–395
01 August 2014

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