Evaluation of the Feasibility and Effectiveness of Placement of Fully Covered Self-Expandable Metallic Stents via Various Insertion Routes for Benign Biliary Strictures

Ko Tomishima; Shigeto Ishii; Toshio Fujisawa; Muneo Ikemura; Mako Ushio; Sho Takahashi; Wataru Yamagata; Yusuke Takasaki; Akinori Suzuki; Koichi Ito; Keiichi Haga; Kazushige Ochiai; Osamu Nomura; Hiroaki Saito; Tomoyoshi Shibuya; Akihito Nagahara; Hiroyuki Isayama

doi:10.3390/jcm10112397

Journal of Clinical Medicine (May 2021)

Evaluation of the Feasibility and Effectiveness of Placement of Fully Covered Self-Expandable Metallic Stents via Various Insertion Routes for Benign Biliary Strictures

Ko Tomishima,
Shigeto Ishii,
Toshio Fujisawa,
Muneo Ikemura,
Mako Ushio,
Sho Takahashi,
Wataru Yamagata,
Yusuke Takasaki,
Akinori Suzuki,
Koichi Ito,
Keiichi Haga,
Kazushige Ochiai,
Osamu Nomura,
Hiroaki Saito,
Tomoyoshi Shibuya,
Akihito Nagahara,
Hiroyuki Isayama

Affiliations

Ko Tomishima: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Shigeto Ishii: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Toshio Fujisawa: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Muneo Ikemura: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Mako Ushio: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Sho Takahashi: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Wataru Yamagata: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Yusuke Takasaki: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Akinori Suzuki: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Koichi Ito: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Keiichi Haga: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Kazushige Ochiai: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Osamu Nomura: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Hiroaki Saito: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Tomoyoshi Shibuya: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Akihito Nagahara: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Hiroyuki Isayama: Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan

DOI: https://doi.org/10.3390/jcm10112397
Journal volume & issue: Vol. 10, no. 11
p. 2397

Abstract

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Background and aims: The goals of the management of benign biliary stricture (BBS) are to relieve symptoms and resolve short-/long-term stricture. We performed fully covered self-expandable metallic stent (hereafter, FCSEMS) placement for BBS using various methods and investigated the treatment outcomes and adverse events (AEs). Methods: We retrospectively studied patients who underwent FCSEMS placement for refractory BBS through various approaches between January 2017 and February 2020. FCSEMS were placed for 6 months, and an additional FCSEMS was placed if the stricture had not improved. Technical success rate, stricture resolution rate, and AE were measured. Results: A total of 26 patients with BBSs that were difficult to manage with plastic stents were included. The mean overall follow-up period was 43.3 ± 30.7 months. The cause of stricture was postoperative (46%), inflammatory (31%), and chronic pancreatitis (23%). There were four insertion methods: endoscopic with duodenoscopy, with enteroscopy, EUS-guided transmural, and percutaneous transhepatic. The technical success rate was 100%, without any AE. Stricture resolution was obtained in 19 (83%) of 23 cases, except for three cases of death due to other causes. Stent migration and cholangitis occurred in 23% and 6.3%, respectively. Stent fracture occurred in two cases in which FCSEMSs were placed for more than 6 months (7.2 and 10.3 months). Conclusion: FCSEMS placement for refractory BBS via various insertion routes was feasible and effective. FCSEMSs should be exchanged every 6 months until stricture resolution because of stent durability. Further prospective study for confirmation is required, particularly regarding EUS-guided FCSEMS placement.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

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