Fully-covered, self-expandable metal stents (CSEMS) in malignant distal biliary strictures: Mid-term evaluation

Mihir Bakhru, Henry C. Ho, Vishal Gohil, Andrew Y. Wang, Kristi Ellen, Bryan G. Sauer, Vanessa M. Shami, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background and Aims: Limited data exist regarding fully-covered, self-expandable metal stents (CSEMS) with anchoring fins for the management of malignant distal biliary strictures. The aim of this study is to evaluate their safety and patency. Methods: Over a period of 2years, 70 patients (45 males, 66±13years) underwent endoscopic retrograde cholangiopancreatography (ERCP) with placement of a 10-mm (67 patients) or 8-mm diameter (3 patients) CSEMS for the palliation of distal malignant biliary obstruction (pancreatic [53] or other [17]). Data were collected prospectively for survival and stent patency; complications were evaluated retrospectively. Results: After CSEMS placement, 17 patients proceeded to surgery, and 53 patients were deemed unresectable. Mean survival for non-surgical candidates was 180days (range: 15-1091), and 170days (range: 9-589) for patients who underwent surgical management. CSEMS were left in place and remained patent for a mean of 163days (range: 15-1091) in non-surgical candidates, and a mean of 55days (range: 5-126) in surgical candidates. Complications during placement included wire perforations (4) and proximal deployment requiring repositioning (4), one of which was complicated by a bile leak. Post-procedure complications were observed in 24 cases (34%) and included post-ERCP pancreatitis (8, with 2 of them severe), post-procedure pain (5, with 3 requiring admission), cholecystitis (3), stent occlusion (3), cholangitis (2), proximal migration (1), post-sphincterotomy bleeding (1), and sepsis leading to death (1). Conclusion: CSEMS appear to provide acceptable short-term patency rates; however, their limited long-term patency and high complication rate might limit their widespread use. Further long-term prospective data are required to confirm this observation.

Original languageEnglish (US)
Pages (from-to)1022-1027
Number of pages6
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number6
StatePublished - Jun 2011
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


  • Biliary
  • Fully-covered
  • Malignant
  • Metal stent
  • Self-expandable
  • Self-expanding metal stent
  • Stricture


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