A fully covered self-expandable metal stent with antimigration features for benign biliary strictures: a prospective, multicenter cohort study.

BACKGROUND

Self-expandable metal stents (SEMSs) are increasingly used for the treatment of benign biliary strictures (BBSs). A new fully covered SEMS (FCSEMS) with flared ends and high conformability was designed to prevent migration of the stent.

OBJECTIVE

To evaluate the efficacy of a novel FCSEMS with antimigration features.

DESIGN

Prospective cohort study.

SETTING

Five hospitals in the Netherlands and Belgium.

PATIENTS

Consecutive patients with BBS.

INTERVENTION

FCSEMS placement for 3 months.

MAIN OUTCOME MEASUREMENTS

Initial and long term clinical success, stent migration rate and safety.

RESULTS

Thirty-eight patients (24 men; mean age, 53 ± 16 years) were included. Stent placement was technically successful in 37 patients (97%). Two patients died of an unrelated cause before stent removal, and no data on these patients were available on stricture resolution. Initial clinical success was achieved in 28 of 35 patients (80%). During follow-up after stent removal, a symptomatic recurrent stricture developed in 6 of 28 patients (21%). Overall, the long-term clinical success rate was 63% (22 of 35 patients). Stent migration occurred in 11 of 35 patients (31%), including 5 symptomatic (14%) and 6 asymptomatic (17%) migrations. In total, 11 serious adverse events occurred in 10 patients (29%), with cholangitis (n = 5) being most common.

LIMITATIONS

Nonrandomized study design.

CONCLUSIONS

Good initial clinical success was achieved after placement of this novel FCSEMS, but stricture recurrence was in the upper range compared with other FCSEMSs. The antimigration design could not prevent migration in a significant number of patients with a persisting stricture.