Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
J Dig Dis. 2014 Mar;15(3):146-53. doi: 10.1111/1751-2980.12117.
Endoscopic placement of covered self-expandable metal stent (SEMS) has gained popularity in the management of benign biliary strictures (BBS). The existing SEMS has been designed primarily to palliate malignant biliary obstruction and has a high frequency of stent migration, difficulty in retrieval and stricture recurrence after stent removal. This study aimed to design a novel retrievable SEMS dedicated to the treatment of extrahepatic BBS and evaluate its clinical efficacy and safety.
A short fully covered SEMS (FCSEMS) with a retrieval lasso was designed for the specific treatment of BBS. A total of 45 patients with segmental extrahepatic BBS were included in this study. The stent was placed entirely inside the bile duct with only the retrieval lasso extending from the papilla. The stents were recommended to be in situ for 6 to 12 months before removal.
The FCSEMS was successfully placed in all 45 patients. In all, 33 patients had their FCSEMS successfully removed after a mean period of 8.6 ± 3.7 (range 2-15.5) months. Stent migration occurred in 9.1% of the patients. During a mean follow-up of 18.9 months after stent removal, recurrent stricture was found in 2 (6.1%) patients and was successfully treated with a second FCSEMS. Overall, the strictures resolved in 30/33 (90.9%) patients.
Intraductal placement of a short FCSEMS is suitable for the treatment of segmental extrahepatic BBS. This new removable design offered prolonged stenting and drainage for BBS for up to one year with minimal complications.
内镜下放置覆盖自膨式金属支架（SEMS）在治疗良性胆管狭窄（BBS）方面已得到广泛应用。现有的 SEMS 主要设计用于缓解恶性胆道梗阻，其支架迁移率高，取出困难，取出后狭窄复发率高。本研究旨在设计一种新型可回收 SEMS，专门用于治疗肝外 BBS，并评估其临床疗效和安全性。
设计了一种短的全覆膜 SEMS（FCSEMS），带有回收套索，专门用于治疗 BBS。本研究共纳入 45 例肝外节段性 BBS 患者。支架完全置于胆管内，仅回收套索从乳头延伸出来。建议在取出前将支架原位放置 6-12 个月。
所有 45 例患者均成功放置 FCSEMS。共有 33 例患者在平均 8.6±3.7（2-15.5）个月后成功取出 FCSEMS。支架迁移发生率为 9.1%。在支架取出后平均 18.9 个月的随访中，发现 2 例（6.1%）患者出现再狭窄，并成功接受了第二次 FCSEMS 治疗。总体而言，30/33 例（90.9%）患者的狭窄得到缓解。
胆管内放置短的 FCSEMS 适用于治疗肝外节段性 BBS。这种新型可回收设计为 BBS 提供了长达一年的支架置入和引流，并发症最小。
