Endoscopy 2019; 51(04): S232-S233
DOI: 10.1055/s-0039-1681867
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT OF OCCLUDED SELF-EXPANDABLE METAL STENTS USED FOR MALIGNANT STRICTURES OF THE BILE DUCT: RESULTS OF A SINGLE-CENTER RETROSPECTIVE STUDY

T Voiosu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine, Carol Davila Medical School, Bucharest, Romania
,
H Zacheu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
,
D Bobeica
2   Internal Medicine, Carol Davila Medical School, Bucharest, Romania
,
M Barbu
3   Medical Oncology, Elias Emergency Hospital, Bucharest, Romania
4   Oncology, Carol Davila Medical School, Bucharest, Romania
,
A Bengus
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
,
A Voiosu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
,
RB Mateescu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine, Carol Davila Medical School, Bucharest, Romania
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Self-expandable metal stents (SEMS) have become a mainstay of palliation for cholestasis in patients with malignant strictures of the bile duct, providing longer patency than plastic stents. There is, however, limited data regarding management of stent dysfunction in these patients, with current guidelines supporting use of both plastic and metal stents. We report our experience with management of SEMS dysfunction.

Methods:

We conducted a retrospective analysis of a prospectively updated database of ERCP procedures in a referral center for endoscopy. We identified all patients who had at least 1 SEMS implanted for a malignant stricture of the bile duct and cases with at least one more endoscopic intervention for stent dysfunction after SEMS implantation were included in the final analysis. Stent dysfunction was defined using a combination clinical, biochemical and imaging data, as per ESGE guidelines. Patient age, gender, diagnosis and bilirubin levels were retrieved, along with data regarding the initial procedure as well as the subsequent management of stent dysfunction.

Results:

One hundred seventeen consecutive patients treated by means of a SEMS for malignant biliary obstruction in our service between October 2016-October 2018 were identified and 18 patients (15.3%) with subsequent stent dysfunction were included in the final analysis. Pancreatic tumors were the most common indication for stenting (11/18). 16/18 patients had an uncovered SEMS initially implanted, with 5 patients having previous plastic stents. Median stent patency was 3 months (range 1 – 26 months). Stent dysfunction was successfully treated by the SEMS-in-SEMS technique in 13/18 cases (72.%), mechanical cleaning with a balloon in 3 cases and plastic stenting in 1 case.

Conclusions:

In our study, relatively few patients presented with stent dysfunction after SEMS implantation. Treatment was usually achieved by means of an additional metal stent; however, plastic stenting or mechanical cleaning were also successfully employed in some cases.