Temporary placement of covered self-expandable metallic stents in patients with biliary leak: midterm evaluation of a pilot study

Michel Kahaleh, Vinay Sundaram, Steven L. Condron, Sarah A. De La Rue, Joshua D. Hall, Jeffrey Tokar, Charles M. Friel, Eugene F. Foley, Reid B. Adams, Paul Yeaton

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background: Management of biliary leaks includes ERCP and stent placement. The ability to temporarily place a partially covered self-expandable metallic stent (CSEMS) might offer an advantage in the treatment of biliary leaks. Objective: We analyzed our 2 years' experience when using this innovative technique. Design: Patients in whom a previous ERCP had failed to resolve a bile leak or patients with severe comorbidities were offered CSEMS and were followed prospectively for clinical and radiologic responses. Setting: Tertiary-care center with long-standing experience of using CSEMS. Patients: A total of 16 patients were included. Of these, 7 had previously undergone unsuccessful plastic stent placement, 3 had previously failed ERCP, and 7 had severe comorbidities that prevented multiple interventions. Intervention: ERCP with placement of a CSEMS covering the cystic duct take-off in the case of a cystic-stump leak. CSEMS were removed after resolution of the leak. Main Outcome Measurements: Efficacy and safety of the CSEMS in bile leaks; complications were also evaluated. Results: Of the patients studied, 15 responded to CSEMS placement with complete resolution of the leak on imaging. One patient with partial cholecystectomy relapsed and underwent drainage; another patient responded to the treatment but required revision because of migration. CSEMS were left in place for a median time of 3 months (range, 1-17 months). Complications included 1 proximal and 1 distal migration. Limitations: Pilot study from a single center. Conclusions: CSEMS is an excellent option in this subgroup of patients not responding to plastic stent placement or with severe comorbidities.

Original languageEnglish (US)
Pages (from-to)52-59
Number of pages8
JournalGastrointestinal Endoscopy
Volume66
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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