Balloon Expandable Biodegradable Biliary Stents in the management of post-surgical biliary strictures

Aims Balloon Expandable Biodegradable Biliary Stents (BEBS) are a recently developed alternative to fully covered self-expandable metallic stent (fcSEMS) without the need for removal /retrieval. As well as the expected reduced morbidity associated with stent dysfunction, migration, and SEMS impaction if patients are ‘lost to follow up’, they may have a role where fcSEMS is precluded by difficulty with retrieval/removal (eg where endoscopic access is difficult/impossible). The 57mm stent Unity B is made of magnesium alloy, can be inflated to 8-10mm, with degradation over 1-3 months. We describe our experience of managing post-surgical strictures inaccessible via ERCP at a large UK tertiary hospital.

Methods The electronic medical record was searched for the terms “biodegradable” & “Unity B” between 2023 and 2024. Patients who opted out of medical research were excluded. The medical records were retrospectively reviewed. Data extracted included patient characteristics, procedure related information and outcomes.

Results Four patients (mean age 62 years, 3F:1M) had ‘Unity B’ BEBS inserted during the study period. All the patients had a 10mm x 5.7cm fast degrading (1-3 month) stent inserted.

Patient 1: History of hepatico-jejunostomy (HJ) & roux-en-Y secondary to choledochal cyst resection. Developed a post-surgical stricture with proximal biliary stones. Underwent percutaneous transheptatic biliary drainage (PTBD), cholangioscopy directed stone treatment and BEBS deployment. Despite developing cholangitis and hemobilia post-procedure a 4-week tubogram showed patent HJ anastomosis, allowing for removal of the PTBD with maintained clinical benefit.

Patient 2: History of HJ for cholangiocarcinoma. Developed a post-surgical stricture with proximal biliary stones. Underwent PTBD and BEBS. MRCP at 4-months confirmed patent anastomosis.

Patient 3: History of HJ for tuberculosis-related biliary disease. Developed a post-surgical stricture with proximal biliary stones. Stones treated with transhepatic cholangioscopy and BEBS placed across HJ stricture. Post-procedure biliary tract hemorrhage due to hepatic artery pseudo-aneurysm related to PTBD insertion requiring emergency embolisation with effective haemostasis. 2-month MRCP scan showed patent HJ anastomosis and no cholangitis.

Patient 4: History of stricture HJ anastomosis for a benign pancreatic head mass. PTBD and cholangioscopy for treatment of intrahepatic stone and BEBS for HJ anastomotic stricture. Well on follow up at 4 months

Conclusions In this small study, insertion of ‘Unity B’ BEBS was a technical and clinical success in 4 patients with post-surgical biliary strictures. Long term follow-up data is required but these stents may have a particular role when fcSEMS use is precluded by difficulty with subsequent removal (eg HJ anastomosis)

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Artikel online veröffentlicht:
27. März 2025