Plastic Stents May Be Superior to Self-Expandable Metallic Stents (SEMS) in Palliating the Very Complex Malignant Hilar Strictures

Background and aims: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10–22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. Methods: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. Results: Technical success of balloon dilation + cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation + cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. Conclusion: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation + cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.

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Superiority of Self-Expandable Metallic Stents (SEMS) Over Plastic Stents (PS) in Treatment of Malignant Distal Biliary Strictures

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2020.12.020 ◽

2020 ◽

Author(s):

Sunguk Jang ◽

Tyler Stevens ◽

Mansour A. Parsi ◽

Amit Bhatt ◽

Adam Kichler ◽

...

Keyword(s):

Metallic Stents ◽

Plastic Stents ◽

Biliary Strictures ◽

Expandable Metallic Stents

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Best period to replace or change plastic stents with self-expandable metallic stents using multivariate competing risk regression analysis

Scientific Reports ◽

10.1038/s41598-020-70081-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Masafumi Chiba ◽

Masayuki Kato ◽

Yuji Kinoshita ◽

Nana Shimamoto ◽

Youichi Tomita ◽

...

Keyword(s):

Regression Analysis ◽

Metallic Stents ◽

Competing Risk ◽

Plastic Stents ◽

Expandable Metallic Stents

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Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma

Endoscopy ◽

10.1055/s-0034-1391304 ◽

2015 ◽

Vol 47 (06) ◽

pp. 508-516 ◽

Cited By ~ 4

Author(s):

Kwang Chung ◽

Sang Lee ◽

Jin Park ◽

Jae Lee ◽

Dong-Won Ahn ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Biliary Drainage ◽

Metallic Stents ◽

Plastic Stents ◽

Endoscopic Biliary Drainage ◽

Expandable Metallic Stents

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Y-Shaped Bilateral Self-Expandable Metallic Stent Placement for Malignant Hilar Biliary Obstruction: Data from a Referral Center for Palliative Care

The Scientific World JOURNAL ◽

10.1155/2014/151502 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

R. Di Mitri ◽

F. Mocciaro

Keyword(s):

Clinical Success ◽

Metallic Stents ◽

Plastic Stents ◽

Metallic Stent ◽

Safe Procedure ◽

Technical Success ◽

Expandable Metallic Stent ◽

Hilar Carcinoma ◽

Malignant Hilar Biliary Obstruction ◽

Expandable Metallic Stents

Background and Aim. Malignant hilar strictures are a clinical challenge because of the current therapeutic approach and the poor prognosis. In recent years, self-expandable metallic stents have proven more effective than plastic stents for palliation of malignant hilar strictures, with the bilateral stent-in-stent technique registering a high success rate. We report our experience with Y-shaped endoscopic self-expandable metallic stents placement for treatment of advanced malignant hilar strictures.Methods. From April 2009 to August 2012, we prospectively collected data on patients treated with Y-shaped SEMS placement for advanced malignant hilar carcinoma. Data on technical success, clinical success, and complications were collected.Results. Twenty patients (9 males) were treated (mean age 64.2 ± 15.3 years). The grade of malignant hilar strictures according to the Bismuth classification was II in 5 patients (25%), IIIa in 1 (5%), and IV in 14 (70%). The mean bilirubin level was 14.7 ± 4.9 mg/dL. Technical success was achieved in all patients, with a significant reduction in bilirubin levels (2.9 ± 1.7 mg/dL). One patient experienced cholangitis as early complication, while in 2 patients stent ingrowth was observed. No stents migration was recorded. There was no procedure-related mortality. At the end of the follow-up (7.1 ± 3.1 months), 13 of the 20 patients (65%) had died.Conclusions. Our experience confirms endoscopic bilateral self-expandable metallic stents placement with stent-in-stent technique (Y-shaped configuration) as a feasible, effective, and safe procedure for palliation of unresectable malignant hilar strictures.

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Endoscopic treatment of anastomotic biliary strictures in patients with living donor liver transplantation: Multiple Plastic Stents Vs Fully Covered Self-Expandable Metallic Stents

10.26226/morressier.59a6b343d462b80290b5426d ◽

2017 ◽

Author(s):

Erkan Parlak

Keyword(s):

Liver Transplantation ◽

Endoscopic Treatment ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Metallic Stents ◽

Plastic Stents ◽

Biliary Strictures ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Expandable Metallic Stents

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Use of self-expandable metallic stents for endoscopic biliary decompression decreases stent complications in pancreatic cancer patients receiving chemotherapy

Surgical Endoscopy ◽

10.1007/s00464-021-08327-y ◽

2021 ◽

Author(s):

Sini Vehviläinen ◽

Hanna Seppänen ◽

Anna Nurmi ◽

Caj Haglund ◽

Harri Mustonen ◽

...

Keyword(s):

Pancreatic Cancer ◽

Neoadjuvant Treatment ◽

Metallic Stents ◽

University Hospital ◽

Plastic Stents ◽

Biliary Decompression ◽

Stent Occlusion ◽

Plastic Stent ◽

Expandable Metallic Stents ◽

Stent Complications

Abstract Background Both plastic stents and self-expandable metallic stents (SEMSes) are used for endoscopic biliary decompression (BD) among patients with pancreatic cancer (PAC). Cholangitis or stent occlusion often interrupts or ends chemotherapy. We investigated cholangitis, stent occlusion, and chemotherapy interruption rates for SEMSes and plastic stents among patients receiving chemotherapy for PAC. Materials and methods We retrospectively analyzed data for 293 PAC patients who received a biliary stent at Helsinki University Hospital during 2000–2017. Patients received chemotherapy as palliative treatment (PT: n = 187) or neoadjuvant treatment (NAT: n = 106). Among participants, 229 had a plastic stent (PT: n = 138, NAT: n = 91) and 64 had a SEMS (PT: n = 49, NAT: n = 15). Results Overall, 15.6% (n = 10) of patients with SEMSes (PT: 20.4%, n = 10, NAT: 0%) and 53.0% (n = 121) of patients with plastic stents (PT: 69.3%, n = 95, NAT: 28.5%, n = 26) experienced one or more stent complications (p < 0.001). Cholangitis developed in 6.3% (n = 8) of PT patients with SEMSes. No patients with SEMSes receiving NAT (n = 15) experienced cholangitis. However, 31.9% (PT: 42.8%, n = 59, p = 0.001; NAT: 15.4%, n = 14, p = 0.211) of patients with plastic stents developed cholangitis. Among all patients receiving NAT or PT, cholangitis interrupted chemotherapy 6 times (9.4%) in SEMS patients and 61 times (26.6%) in plastic stent patients (p = 0.004). Stent occlusion without cholangitis interrupted NAT or PT 2 times (2.1%) in SEMS patients and 31 times (13.5%) in plastic stent patients (p = 0.023). Conclusions SEMS is recommended for BD among patients with PAC receiving chemotherapy. Among both PT and NAT patients, patients with SEMS experience a lower stent failure rate, lower rate of cholangitis, and fewer chemotherapy interruptions than patients with plastic stents.

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