Impact of Fully Covered Metal Stent Placement in Refractory Postoperative Hilar and Anastomotic Strictures
|Mitsuyoshi Honjo1, Takao Itoi1*, Atsushi Sofuni1, Takayoshi Tsuchiya1, Shujiro Tsuji1, Nobuhito Ikeuchi1, Kentaro Kamada1, Reina Tanaka1, Junko Umeda1, Ryosuke Tonozuka1, Shuntaro Mukai1, Mitsuru Fujita1, Fuminori Moriyasu1 and Hiroyuki Watanabe2|
|1Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan|
|2Akita Kousei Medical Center, Japan|
|Corresponding Author :||Takao Itoi
Department of Gastroenterology and Hepatology
Tokyo Medical University, 6-7-1 Nishishinjuku
Shinjuku-ku, Tokyo 160-0023, Japan
E-mail: [email protected]
|Received February 06, 2016; Accepted February 17, 2016; Published February 24, 2016|
|Citation: Honjo M, Itoi T, Sofuni A, Tsuchiya T, Tsuji S, et al. (2016) Impact of Fully Covered Metal Stent Placement in Refractory Postoperative Hilar and Anastomotic Strictures. Adv Tech Biol Med 4:169. doi:10.4172/2379-1764.1000169|
|Copyright: © 2016 Honjo M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Introduction: Biliary stricture can occur following surgeries of the biliary tract and can cause biliary congestion and cholangitis. Recently, fully covered self-expandable metal stent (FCSEMS) has been utilized for postoperative hilar and anastomotic strictures that have conventionally been considered difficult to treat. On the other hand, there is no solid evidence regarding optimal metal stent placement period.
Method: Retrospective review of patients treated for postoperative benign biliary stricture using a FCSEMS at our hospital between 2013 and 2015.
Results: We performed a total of 14 metal stent placements for 12 patients with postoperative benign biliary stricture. In all the patients, the metal stents were placed endoscopically and removed safely after the placement. The mean duration of stent placement was 47.9 days (28-144), and there was no retrograde cholangitis observed during metal stent placement. Following metal stent removal, the stricture improved in 9 patients. Recurrence developed in 3 patients, recurring bile duct stones in 2 patients, and cholangitis in 1 patient. Adverse events included post-ERCP pancreatitis in 2 patients, which was alleviated by stent removal the following day and conservative treatment in 1 patient, and conservative treatment only in the other patient. Distal stent migration was observed in 2 patients.
Conclusion: The present results suggest that stricture improvement can be expected in a shorter period by metal stent placement in patients with refractory postoperative biliary stricture. In patients with bile duct stones, lithectomy can be safely and effectively performed following metal stent expansion; however, further studies are required.