Temporary self-expandable metal stent placement for treatment of post-sphincterotomy bleeding.

BACKGROUND

Endoscopic sphincterotomy (ES) is a basic technique for performing therapeutic interventions during ERCP. Bleeding after ES is a recognized complication and can be difficult to treat.

OBJECTIVE

To evaluate the role of temporary placement of fully covered self-expandable metal stents (SEMSs) for the treatment of difficult-to-control post-ES hemorrhage.

DESIGN

Retrospective case series.

SETTING

Interventional endoscopy unit at a tertiary care referral hospital.

PATIENTS

Five patients treated with temporary SEMSs for difficult-to-control post-ES hemorrhage.

INTERVENTIONS

ERCP with placement of fully covered, biliary SEMSs and subsequent stent removal within 8 weeks.

MAIN OUTCOME MEASUREMENTS

Technical success of SEMS placement, clinical success with hemostasis, complications related to SEMS placement and removal.

RESULTS

Five patients were treated with temporary fully covered SEMSs for post-ES hemorrhage over an 8-month period. Hemostasis was achieved in all patients. Within 8 weeks of the procedure, the SEMSs were easily removed in 3 patients; the SEMSs had spontaneously migrated without incident in the other 2. No other complications were seen.

LIMITATIONS

Retrospective series with a small number of patients.

CONCLUSIONS

Temporary placement of fully covered SEMSs across the biliary orifice seems to be an effective treatment for post-ES hemorrhage. However, stent migration is a concern and may limit this therapy in certain settings.