Mark Jacob A, Mack Cara L, Marwan Ahmed I, Kramer Robert E
Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute.
Division of Pediatric Surgery, Colorado Fetal Care Center, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO.
J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):e71-e75. doi: 10.1097/MPG.0000000000001723.
Endoscopic retrograde cholangiopancreatography is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been used in this population for obstructive lesions and bile leaks; however, they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. Their use in pediatrics has, however, not been defined. The aim of the present study is to describe our experience with FCSEMS at our institution.
We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including 3 adolescents and 1 young adult with complex medical needs.
Patient age range was 12 to 24 years and the weight ranged between 36 and 75 kg. All patients underwent previous endoscopic retrograde cholangiopancreatography and 1 or more rounds of plastic stenting without adequate clinical response before consideration of FCSEMS placement. Indications included recalcitrant biliary anastomotic stricture after liver transplant, persistent bile leak after needle perforation, recurrent obstructive choledocholithiasis after cholecystectomy, and malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6 to 8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal.
FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group.
内镜逆行胰胆管造影术用于处理儿科患者的胆道病变。塑料胆道支架已用于该人群的梗阻性病变和胆漏；然而，由于移位、堵塞或密封无效，它们有时并不有效。全覆膜自膨式金属支架（FCSEMS）直径更大，使其更适用于某些情况。然而，其在儿科中的应用尚未明确。本研究的目的是描述我们机构使用FCSEMS的经验。
我们呈现了在科罗拉多儿童医院接受FCSEMS置入的所有患者系列，包括3名青少年和1名有复杂医疗需求的青年成人。
患者年龄范围为12至24岁，体重在36至75千克之间。所有患者之前均接受过内镜逆行胰胆管造影术，在考虑置入FCSEMS之前，进行了1轮或多轮塑料支架置入，但临床反应不佳。适应证包括肝移植后顽固性胆道吻合口狭窄、穿刺后持续性胆漏、胆囊切除术后复发性梗阻性胆总管结石以及恶性胆道狭窄。FCSEMS的尺寸取决于患者胆管大小和胆道病变情况。留置时间为6至8周。3例患者在FCSEMS治疗后胆道病变得到缓解。1例患者的FCSEMS发生远端移位，需要再次置入支架。FCSEMS置入或取出均未发生不良事件。
当塑料胆道支架无效时，应考虑对合适的儿科患者进行FCSEMS治疗。需要进一步研究来评估FCSEMS在儿科年龄组中的安全性和有效性。
