scholarly journals Percutaneous solutions for biliary stent dysfunction: pictorial essay

2021 ◽  
Vol 54 (1) ◽  
pp. 43-48
Author(s):  
Thiago Franchi Nunes ◽  
Tiago Kojun Tibana ◽  
Gustavo Henrique Vieira de Andrade ◽  
Raphael Braz Levigard ◽  
Felipe Diniz Nogueira ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Intestinal Obstruction ◽  
Vascular Complications ◽  
Biliary Stent ◽  
Biliary Disease ◽  
Positioning Error ◽  
Biliary Stents ◽  
Liver Capsule ◽  
Pictorial Essay

Abstract Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

scholarly journals A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-56
Author(s):  
D R Lim ◽  
M Tsai ◽  
S E Gruchy ◽  
J Jones ◽  
G Williams ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Nova Scotia ◽  
Stent Placement ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Occlusion ◽  
Stent Removal ◽  
Kaplan Meier ◽  
And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

Future Directions of Percutaneous Biliary Interventions

2021 ◽  
Vol 38 (03) ◽  
pp. 373-376
Author(s):  
Ahsun Riaz ◽  
Riad Salem
Keyword(s):  
Interventional Radiology ◽  
Biliary Disease ◽  
Future Directions ◽  
Safety And Efficacy ◽  
Interventional Radiologist ◽  
Imaging Guidance ◽  
The Future ◽  
Biliary Interventions

AbstractWe are at an exciting cross-road in biliary interventions. While other services such as surgery and gastroenterology have learned to use imaging guidance to improve the safety and efficacy of their procedures, it is time for interventional radiologist to learn endoscopic interventions to achieve the same. The future of interventional radiologists in managing patients with biliary disease depends on (1) increasing comfort of our procedures, (2) publishing our data on biliary interventions, and (3) increasing collaboration with other services to manage biliary disease. We need to appropriately understand the limitations of interventional radiology to help guide the future directions of our specialty in this very interesting space.

scholarly journals Complications due to Biliary Stent Deviation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kinoshita Kumar ◽  
◽  
Fukuchi S ◽  
Murakami K ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sphincterotomy ◽  
Clinical Symptoms ◽  
Acute Cholangitis ◽  
Biliary Stent ◽  
Plastic Stents ◽  
Duodenal Perforation ◽  
Early Complications ◽  
Biliary Stents ◽  
Uterine Appendage

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

scholarly journals Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

2020 ◽  
Vol 08 (12) ◽  
pp. E1895-E1899
Author(s):  
Patrick Yachimski ◽  
Jordan K. Orr ◽  
Anthony Gamboa
Keyword(s):  
Perceived Risk ◽  
Primary Outcome ◽  
Bile Leak ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Plastic Stent ◽  
Subtotal Cholecystectomy ◽  
Bile Leaks ◽  
Study Inclusion

Abstract Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy. Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP). Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87 % of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13 % (8/61). Leak resolution was evident at first follow-up ERCP in 96 % of subjects (26/27) who had undergone total cholecystectomy and 91 % of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96 % (23/24) of those who had undergone total cholecystectomy and 90 % (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62). Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.

scholarly journals Interventional radiology-operated endoscopy-assisted retrograde transnasal placement of a retrievable transhepatic covered biliary stent

2018 ◽  
Vol 13 (1) ◽  
pp. 153-155 ◽  
Author(s):  
Evan Johnson ◽  
Kyle J. Cooper ◽  
Jeffrey Forris Beecham Chick ◽  
Joseph J. Gemmete ◽  
Ravi N. Srinivasa
Keyword(s):  
Interventional Radiology ◽  
Biliary Stent

scholarly journals A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Özkan Yilmaz ◽  
Remzi Kiziltan ◽  
Oktay Aydin ◽  
Vedat Bayrak ◽  
Çetin Kotan
Keyword(s):  
Incisional Hernia ◽  
Intestinal Tract ◽  
Rare Complication ◽  
Bowel Perforation ◽  
Stent Migration ◽  
Biliary Stent ◽  
Small Bowel Perforation ◽  
Malignant Diseases ◽  
Biliary Stents ◽  
Pass Through

Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.

Severe Vascular Complications Of Acute Pancreatitis

2015 ◽  
Vol 87 (10) ◽  
Author(s):  
Stanisław Głuszek ◽  
Łukasz Nawacki ◽  
Jarosław Matykiewicz ◽  
Marta Kot ◽  
Jakub Kuchinka
Keyword(s):  
Acute Pancreatitis ◽  
Interventional Radiology ◽  
Surgical Treatment ◽  
Mortality Rate ◽  
Conservative Treatment ◽  
Vascular Complications ◽  
Abdominal Ultrasound ◽  
Etiological Factor ◽  
Study Group ◽  
Endovascular Embolisation

AbstractAcute pancreatitis (AP) develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%.The study included 10 patients treated due to acute pancreatitis in two surgical departments run by one of the authors (S.G.) in the years 2004-2014, who developed a serious complication in the form of haemorrhage into the inflammatory tumour/pancreatic cyst or an adjacent organ. Haemorrhage was diagnosed based on the clinical picture, most often a sudden drop in blood pressure, peritonitis symptoms and imaging findings – abdominal ultrasound and abdominal computed tomography. Therapeutic methods included conservative treatment, endovascular embolisation and, in the absence of efficacy of the above mentioned methods, surgical treatment. Patients age and gender, the etiological factor, comorbidities, Atlanta Classification, treatment outcomes and mortality rate were assessed.Alcohol was the most common etiological factor in the investigated AP cases. The patients received conservative treatment, interventional radiology treatment (endovascular embolisation) or surgical treatment. In the study group, 6 patients required surgical treatment, 3 patients received invasive radiology treatment, and conservative treatment was used in one patient. The mortality rate in the study group was 30%.Haemorrhages into the inflammatory cisterns or adjacent organs (stomach, transverse colon mesentery) secondary to AP are the most severe complications, which are difficult to manage. The successful use of interventional radiology methods to inhibit and prevent the recurrence of bleeding in some of the patients is a significant milestone.

scholarly journals Drug-eluting Biliary Stent

2020 ◽  
Vol 25 (1) ◽  
pp. 11-17
Author(s):  
Sung Ill Jang ◽  
Dong Ki Lee
Keyword(s):  
Biliary Drainage ◽  
Development Process ◽  
Primary Treatment ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Patency ◽  
Future Directions ◽  
The Past ◽  
Drug Eluting

Biliary drainage is necessary to improve the survival or quality of life of patients with malignant biliary obstruction. In the past, surgery was the primary treatment for biliary drainage, but recently, endoscopic or percutaneous stent implantation has been recognized as the main treatment. Various materials and structures have been devised and developed to increase the patency of the biliary stent. In the development of these stents, drug-eluting biliary stents with an anti-tumoral agent (DES) have emerged to increase the stent patency period by chemically inhibiting tumor growth in the stent through the change of the coating material. The DESs have been proved to be stable through several animal and clinical trials, but their effectiveness has not been demonstrated. We will discuss the development process, problems, and future directions of DES that has been clinically applied.

Sign in / Sign up

Export Citation Format

Share Document