Metal Stents Resolve Painful Narrowed Bile Ducts

Temporary metal stents can effectively mend painful and potentially life-threatening benign biliary strictures (BBS), according to a new study.

Researchers at Weill Cornell Medical College (New York, NY, USA) conducted a retrospective multicenter study involving 133 patients (mean age 60 years, 58.6% males) with BBS who received a fully covered self-expanding metal stent (FCSEMS) with flared ends between April 2009 and October 2010. Efficacy of treatment was measured (after removal of the FCSEMS) by evaluating stricture resolution based on symptoms, imaging, laboratory studies, and/or choledochoscopy at removal. The safety profile was evaluated by assessing postprocedural complications.

The results showed that stricture resolution after FCSEMS removal was 91.6% successful in post-surgical cases, 84.2% in gallstone related disease, 80.7% in chronic pancreatitis, and 80% in other etiologies. In more complex anastomotic strictures cases, the procedure was 61.2% successful. In all, nearly 73% of the metal stents were successfully removed after an average of three months. The study was published ahead of print on February 22, 2013, in the Journal of Clinical Gastroenterology.

“Fully covered self-expanding metal stents are emerging as a promising therapeutic option in the treatment of benign bile duct strictures,” said lead author Professor of clinical medicine Michel Kahaleh, MD. “We found very acceptable, high rates of stricture resolution after the use and removal of metal stents in all types of patients groups. Interestingly, patients who had stents placed for more than three months were 4.3 times more likely to have resolved strictures, while those with nonmigrated stents were 5.4 times more likely to have resolved strictures.”

Biliary strictures (both malignant and benign) can lead to dangerous bile leakage into various organs and the bloodstream, with symptoms such as jaundice, severe pain, itchiness, weight-loss, elevated liver function tests, cirrhosis, and liver failure over a period of a few weeks. A benign stricture can occur as a result of surgical injury or trauma, pancreas inflammation, scarring or hardening of bile duct tissue caused by chronic inflammation, recurrent gallstones, or poor reconnection of tissues following liver transplantation.

While surgery once played a pivotal role in the management of BBS, minimally invasive endoscopic stent placement has emerged as a less invasive and more successful therapeutic option. FCSEMS are being tested in patients with BBS to overcome the limitations of plastic stents, and the complications of their uncovered or semi-covered metal stent counterparts. The fully covered membrane design of FCSEMS prevents embedding of the stent into the bile duct wall.

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Weill Cornell Medical College