Year 2013 / Volume 105 / Number 1
Original
Fully covered self-expanding metal stents in the management of difficult common bile duct stones

pp. 7-12

Jesús García-Cano, Amanda Karolina Reyes Guevara, Teresa Martínez Pérez, Laura Valiente González, Raquel Martínez Fernández, Miriam Viñuelas Chicano, Carmen Julia Gómez Ruiz, Julia Morillas Ariño, Gracia Pérez Vigara, José Ignacio Pérez García y Ángel Pérez Sola

Abstract
Background and objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction.

Patients and methods: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphinc- terotomy and a single plastic stent would not provide an adequate drainage.

Results: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endosco- pist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not remo- ved in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken.

Conclusions: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.
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Jesús García-Cano, Amanda Karolina Reyes Guevara, Teresa Martínez Pérez, Laura Valiente González, Raquel Martínez Fernández, Miriam Viñuelas Chicano, Carmen Julia Gómez Ruiz, Julia Morillas Ariño, Gracia Pérez Vigara, José Ignacio Pérez García y Ángel Pérez Sola. Fully covered self-expanding metal stents in the management of difficult common bile duct stones. 7-12


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