Assessment of an intraductal metallic stent in the management of postcholecystectomy biliary strictures

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Shehab H.; Youssef S.; Hamada Y.; Elghannam M.; Abdelaziz A.; Elserafy M.

Journal: iGIE

Publisher: Elsevier B.V.

Publication Date: September 2023

Volume / Issue: Volume 2 / Issue 3

Pages: 305–311

ISSN: 29497086

DOI: 10.1016/j.igie.2023.06.001

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Shehab H., Gastroenterology Division, Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Youssef S., Gastroenterology Department, Theodor Bilharz Institute, Cairo, Egypt; Hamada Y., Gastroenterology Division, Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Elghannam M., Gastroenterology Department, Theodor Bilharz Institute, Cairo, Egypt; Abdelaziz A., Gastroenterology Department, Theodor Bilharz Institute, Cairo, Egypt; Elserafy M., Gastroenterology Division, Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt

Abstract

Background and Aims: Postcholecystectomy bile duct strictures are currently managed by using multiple plastic stents. The use of metallic stents has been considered a contraindication due to fear that the metallic stent could block one of the main hepatic ducts. This study is the first to assess the use of an intraductal, fully covered metallic stent in postcholecystectomy strictures, including those with close proximity to the hepatic hilum. Methods: This study was a retrospective analysis of 11 patients who underwent insertion of an intraductal metallic stent for the management of postcholecystectomy strictures. In those strictures close to the hepatic hilum (Bismuth types II, III, and IV), a 7F plastic stent was inserted in the contralateral hepatic duct to maintain its patency. Stent extraction was planned after 6 to 12 months. Results: All stents were inserted successfully. After a median indwell time of 10 months (range, 3-15 months), all stents were successfully extracted. Strictures resolved in 10 patients (91%) at the time of stent extraction. One patient had premature extraction of the stent at 3 months due to stent obstruction. After a median follow-up of 24 months (range, 10-52 months), stricture recurrence occurred in 4 (40%) of 10 patients. No stent migration occurred, nor were there any cases of unilateral bile duct obstruction by the metallic duct. Conclusions: In postcholecystectomy biliary strictures, intraductal, fully covered metallic stents were effective even in strictures close to or involving the biliary bifurcation when an additional 7F plastic stent was inserted. Effective long-term stricture resolution was achieved in a substantial proportion of patients using a low number of endoscopic procedures and no reported stent migration. © 2023 American Society for Gastrointestinal Endoscopy

Citation Information

Scopus Citations: 1

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