BMC Gastroenterology (Dec 2019)

Treatment of post-cholecystectomy biliary strictures with fully-covered self-expanding metal stents – results after 5 years of follow-up

  • Andrea Tringali,
  • D. Nageshwar Reddy,
  • Thierry Ponchon,
  • Horst Neuhaus,
  • Ferrán González-Huix Lladó,
  • Claudio Navarrete,
  • Marco J. Bruno,
  • Paul P. Kortan,
  • Sundeep Lakhtakia,
  • Joyce Peetermans,
  • Matthew Rousseau,
  • David Carr-Locke,
  • Jacques Devière,
  • Guido Costamagna,
  • for the Benign Biliary Stenoses Working Group

DOI
https://doi.org/10.1186/s12876-019-1129-3
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 10

Abstract

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Abstract Background Endoscopic treatment of post-cholecystectomy biliary strictures (PCBS) with multiple plastic biliary stents placed sequentially is a minimally invasive alternative to surgery but requires multiple interventions. Temporary placement of a single fully-covered self-expanding metal stent (FCSEMS) may offer safe and effective treatment with fewer re-interventions. Long-term effectiveness of treatment with FCSEMS to obtain PCBS resolution has not yet been studied. Methods In this prospective multi-national study in patients with symptomatic benign biliary strictures (N = 187) due to various etiologies received a FCSEMS with scheduled removal at 6–12 months and were followed for 5 years. We report here long-term outcomes of the subgroup of patients with PCBS (N = 18). Kaplan Meier analyses assessed long-term freedom from re-stenting. Adverse events were documented. Results Endoscopic removal of the FCSEMS was achieved in 83.3% (15/18) of patients after median indwell of 10.9 (range 0.9–13.8) months. In the remaining 3 patients (16.7%), the FCSEMS spontaneously migrated and passed without complications. At the end of FCSEMS indwell, 72% (13/18) of patients had stricture resolution. At 5 years after FCSEMS removal, 84.6% (95% CI 65.0–100.0%) of patients who had stricture resolution at FCSEMS removal remained stent-free. In addition, at 75 months after FCSEMS placement, the probability of remaining stent-free was 61.1% (95% CI 38.6–83.6%) for all patients. Stent or removal related serious adverse events occurred in 38.9% (7/18) all resolved without sequalae. Conclusions In patients with symptomatic PCBS, temporary placement of a single FCSEMS intended for 10–12 months indwell is associated with long-term stricture resolution up to 5 years. Temporary placement of a single FCSEMS may be considered for patients with PCBS not involving the main hepatic confluence. Trial registration numbers NCT01014390; CTRI/2012/12/003166; Registered 17 November 2009.

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