Use of Covered Metallic Stents in the Management of Benign Biliary Strictures

Introduction: Chronic pancreatitis (CP), inflammatory conditions, anastomotic strictures from liver transplantation and choledocholithiasis, among other conditions, can cause benign biliary strictures (BBS). Serious and irreversible complications such as recurrent cholangitis, secondary biliary cirrhosis, and end-stage liver disease can be the result of BBS so promptness on treating this condition is essential. The definitive treatment for benign extrahepatic bile duct strictures consist of surgery with creation of an enterobiliary anastomosis which can be associated with significant morbidity. An alternative to surgical procedure is the endoscopic placement of plastic stents but long-term outcome has been unsatisfactory. Covered metallic stents (CMS) were developed to overcome the disadvantages of uncovered metallic stents such as mucosal hyperplasia what makes it almost impossible to remove. Although CMS are recommended to be used in patients with unresectable malignancy, its characteristic of easy removal also makes them ideal for benign strictures.

Case: We report a case of a 76 year-old Caucasian male with history of BBS due to severe pancreatitis. This was thought to be a gallstone pancreatitis in nature secondary to the extensive fibrotic changes of his pancreas. The patient had prior ERCP’s in outside institution with plastic stent placement and unsuccessful removal of stones and debris within his CBD secondary to a severe high-grade stricture distally.
We treated the patient with placement of a CMS that was exchanged in four weeks for a new one. Four weeks after the replacement, the stent was removed without any difficulties. The cholangiogram showed that the area of the stricture was significantly dilated to a more normal caliber. The intrahepatic branches that were mildly dilated improved from the prior ERCP and the CBD diameter proximal to the stricture decreased in size from a prior ERCP (18mm to 12mm). The rest of the cholangiogram shows no filling defects and excellent drainage was noted at the end of procedure.

Conclusions: Temporary placement of CMS may be an alternative to surgery in the poor surgical candidate and also to plastic and partially covered stents to treat BBS.

Session: Poster

Program Number: P439