García-Cano Jesús, Reyes-Guevara Amanda Karolina, Martínez-Pérez Teresa, Valiente-González Laura, Martínez-Fernández Raquel, Viñuelas-Chicano Miriam, Gómez-Ruiz Carmen Julia, Morillas-Ariño Julia, Pérez-Vigara Gracia, Pérez-García José Ignacio, Pérez-Sola Ángel
Rev Esp Enferm Dig. 2013 Jan;105(1):7-12. doi: 10.4321/s1130-01082013000100003.
plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction.
after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage.
a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken.
in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.
在未完全取出胆总管结石（CBDS）的内镜逆行胰胆管造影（ERCP）术后，常使用塑料胆管支架。有时，这些支架的胆汁引流体积可能不足。我们介绍在不完全取出CBDS的情况下使用全覆膜自膨式金属支架（FCSEMS）的经验。
在ERCP术中未能完全取出困难的CBDS后，当认为胆管括约肌切开术和单个塑料支架不能提供充分引流时，部分患者插入了胆管FCSEMS（Wallflex）。
进行了一项回顾性研究。29例患者插入了胆管FCSEMS，平均年龄81岁。由于结石体积大（n = 18）或存在炎性远端狭窄（n = 11），无法通过胆管括约肌切开术取出CBDS。由于患者临床不稳定和/或内镜医师给予的清醒镇静耐受性差，认为必须实现最大胆汁引流且ERCP时间最短。所有病例均成功实现胆汁引流。16例患者在中位199.5天后取出FCSEMS，其中15例（93.7%）完全取出了CBDS。其余13例患者由于临床状况未取出FCSEMS，采取了观察等待策略。
在特定病例中，对于困难的CBDS，使用可取出的FCSEMS可能是快速且充分胆汁引流的良好选择。由于这些支架成本较高，其使用需要个体化。
