Covered self-expandable biliary stents for the treatment of bleeding after ERCP

Valats, Jean-Christophe; Funakoshi, Natalie; Bauret, P.; Hanslik, Bertrand; Dorandeu, Anne; Christophorou, Dimitri; Bismuth, Michaël; Blanc, Pierre

doi:10.1016/j.gie.2013.02.035

Cited by 19 publications

(13 citation statements)

References 13 publications

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“…Cap-assisted end-viewing endoscopy using endoclips successfully controlled the hemorrhage in 90% cases, resolving the problem of kink when passing through the elevator of the instrument channel through a side-viewing endoscopy [17, 18]. Fully covered metallic biliary stents have also been applied in post-ES bleeding and have afforded good outcomes [19]. However, higher cost and the need for repeat ERCP for the removal of the stent limit the widespread application of this method.…”

Section: Discussionmentioning

confidence: 99%

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding

Lin

Hung

et al. 2017

PLoS ONE

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Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6%) patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029), end-stage renal disease (P = 0.038), previous antiplatelet drug use (P<0.001), and duodenal ulcer (P = 0.023). The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days), and 60% (12/20) of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7), and 65% (13/20) of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042) and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively). Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each therapeutic modalities and appropriate management of different levels bleeding are important.

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Section: Discussionmentioning

confidence: 99%

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding

Lin

Hung

et al. 2017

PLoS ONE

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“…Although the performance of small-capacity forceps may be lesser than the standard forceps to detect neoplasia [1], it can be useful to avoid uncontrolled hemobilia. CSEMS placement has been recently reported to be a method for achieving endoscopic hemostasis in case of bleeding that cannot be controlled using conventional means [3][4][5]. Although CSEMSs may apply stronger pressure to the bile duct wall than that applied by EBPSs for hemostasis, we placed an EBPS.…”

Section: Discussionmentioning

confidence: 99%

“…Severe bleeding is rare [1][2][3] and invasive interventions including percutaneous radiologic hemostasis or surgery are required [4,5]. Recently, a covered self-expandable metal stent (CSEMS) was reported to be used for the treatment of massive hemobilia during ERCP [3,4].…”

Section: Introductionmentioning

confidence: 99%

Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video)

Shinjo

Matsubayashi

Matsui

et al. 2016

Clin J Gastroenterol

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A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs.

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“…Recently, the temporary placement of fully-covered metal stents (FCMS) into the biliary tree to achieve a tamponade effect has been described as an additional therapeutic option for PSB 5– 8 . The aim of this article is to review the literature on FCMS for hemostasis in PSB and update the treatment algorithm for this complication 1 .…”

Section: Introductionmentioning

confidence: 99%

Post-sphincterotomy bleeding: fully-covered metal stents for hemostasis

DeBenedet

Elta

2013

F1000Res

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Background/objectives: In endoscopic retrograde cholangiopancreatography, post-sphincterotomy bleeding (PSB) is a common complication of biliary sphincterotomy. Recently, the temporary placement of fully-covered metal stents (FCMS) into the biliary tree in order to achieve a tamponade effect has been described as an additional therapeutic option for PSB. The aim of this article is to review the literature on FCMS for hemostasis in PSB and update the treatment algorithm for this complication. Methods: A PubMed literature search was conducted using the search terms post-sphincterotomy, bleeding, and stent. 33 articles were reviewed, along with their references, and four were found to describe the use of FCMS for hemostasis in PSB. Results: A total of 21 patient cases were described in the four articles. All patients received FCMS for PSB hemostasis following the application and subsequent failure of traditional therapies (conventional pharmacologic injection, thermal or electrocoagulation, and mechanical therapy (balloon tamponade or endoclip)). Successful hemostasis was achieved in all patients through FCMS placement. No major complications were observed. Conclusion: These 21 cases demonstrate that FCMS are a viable therapeutic option for PSB. It is reasonable to consider stent placement for patients in which traditional interventions fail in order to avoid the need for angiographic or surgical hemostasis.

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Covered self-expandable biliary stents for the treatment of bleeding after ERCP

Cited by 19 publications

References 13 publications

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding

Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video)

Post-sphincterotomy bleeding: fully-covered metal stents for hemostasis

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