Management of Occluded Uncovered Metallic Stents in Patients With Malignant Distal Biliary Obstructions Using Covered Metallic Stents

Togawa, Osamu; Kawabe, Takao; Isayama, Hiroyuki; Nakai, Yousuke; Sasaki, Takashi; Arizumi, Toshihiko; Matsubara, Saburou; Ito, Yukiko; Yamamoto, Natsuyo; Sasahira, Naoki; Hirano, Keisuke; Tsujino, Takeshi; Toda, Nobuo; Tada, Minoru; Yoshida, Haruhiko; Omata, Masao

doi:10.1097/mcg.0b013e31803d0f80

Cited by 52 publications

(47 citation statements)

References 17 publications

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“…Occluded SEMS further result in biliary stone/sludge formation and recurrent cholangitis [85]. In addition, SEMS present for years in the biliary system might cause serious vascular complications in liver transplant patients [86].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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“…Many retrospective series have demonstrated that it developed in 5%-40% of patients who underwent an endoscopic palliative treatment with SEMS [14][15][16][17][18][19] . The causes of occluded SEMS include tumor ingrowth, overgrowth, sludge/debris formation and stent migration ( Table 1).…”

Section: Occlusionmentioning

confidence: 99%

“…Many studies have shown that one fourth of all SEMS occlusions resulted from tumor overgrowth [14][15][16][17][18][19] . Because tumor can grow and invade over both ends of the stent, covered and uncovered SEMSs have an equal chance to develop tumor overgrowth.…”

Section: Occlusionmentioning

confidence: 99%

“…The causes of occluded SEMS include tumor ingrowth, overgrowth, sludge/debris formation and stent migration ( Table 1). The most common cause of SEMS occlusion is tumor ingrowth, which accounted for 60%-90% of all SEMS occlusion [14][15][16][17][18][19] . This complication is more common in uncovered SEMS, which has an open-mesh, resulting in tissue growing into the stent easily [20,21] .…”

Section: Occlusionmentioning

confidence: 99%

“…Currently, there are three endoscopic techniques that provide re-drainage for SEMS occlusion: (1) mechanical cleaning with a balloon; (2) PS insertion; and (3) SEMS insertion [14][15][16][17][18][19] .…”

Section: Endoscopic Managementmentioning

confidence: 99%

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Management of an occluded biliary metallic stent

Ridtitid

Rerknimitr²

2012

WJGE

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In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.

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Tips and troubleshooting for transpapillary metal stenting for distal malignant biliary obstruction

Hamada

Isayama

Nakai

et al. 2013

J Hepato Biliary Pancreat

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Endoscopic placement of a self-expandable metal stent (SEMS) has become a mainstream treatment to relieve non-resectable distal malignant biliary obstructions-its longer patency and cost-effectiveness were demonstrated in comparison with plastic biliary stents in several randomized controlled trials. Despite advances in ERCP devices and SEMSs themselves to enable safe and effective biliary drainage via a SEMS, several significant aspects of the endoscopic placement of SEMS must be considered; otherwise, SEMS-related complications and early SEMS dysfunction may occur. Also, SEMS dysfunction, including occlusion and migration, occurs at a certain frequency in the long term, and appropriate reintervention is necessary to preserve the quality of life of the patient. Here, we present tips for endoscopic transpapillary SEMS placement for distal malignant biliary obstruction and reintervention for SEMS dysfunction.

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Management of Occluded Uncovered Metallic Stents in Patients With Malignant Distal Biliary Obstructions Using Covered Metallic Stents

Abstract: Insertion of a covered EMS is an effective and safe treatment for an occluded uncovered EMS.

Cited by 52 publications

References 17 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Management of an occluded biliary metallic stent

Tips and troubleshooting for transpapillary metal stenting for distal malignant biliary obstruction

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