Endoscopy 2009; 41(9): 781-786
DOI: 10.1055/s-0029-1215050
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data – a case series[1]

A.  Y.  Wang1 , K.  Ellen1 , C.  L.  Berg1 , T.  M.  Schmitt2 , M.  Kahaleh1
  • 1Digestive Health Center of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
  • 2Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Further Information

Publication History

submitted 1 April 2009

accepted after revision 8 July 2009

Publication Date:
19 August 2009 (online)

Introduction

Biliary leaks typically occur following traumatic injury [1] [2] or surgical intervention, such as cholecystectomy, partial hepatic resection, and liver transplantation. A clinically significant postoperative bile leak occurs in 0.1 % – 0.5 % of open cholecystectomies [3], 0.8 % – 2 % of laparoscopic cholecystectomies [3] [4] [5] [6], about 12 % of cadaveric liver transplantations [7], and 6 % – 14 % of hepatic resections [8].

The role of endoscopic therapy in the treatment of bile leaks is well established. Therapeutic endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy [3] [9], placement of a transpapillary biliary stent [1] [3] [8] [9], or combination biliary sphincterotomy and stenting [3] [9] has become the first-line intervention in the treatment of a bile leak. For high-grade bile leaks, sphincterotomy alone has been shown to be less effective than transpapillary biliary stenting [3], and combined biliary sphincterotomy and transpapillary stenting is preferable in such situations [3] [10]. ERC has been shown to be effective in resolving 70 % – 100 % of postcholecystectomy bile leaks [3] and up to 84 % of bile leaks after cadaveric liver transplant [11]. Large or complex bile leaks require the placement of multiple large stents that span the bile leak and the sphincter of Oddi, but surgery is sometimes still required [3] [11] [12] [13].

Previously, we have described the use of partially covered self-expandable metallic stents (PCMS) in the treatment of complex bile leaks [14] and benign biliary strictures [15]. Although PCMS were effective in resolving bile leaks and benign strictures, they were prone to migration and mucosal hyperplasia at the uncovered ends [14] [15].

Recently, a fully covered self-expandable metallic stent (CSEMS) has become available for endoscopic deployment. This CSEMS has anchoring fins positioned at opposite ends of the stent to reduce stent migration [16] [17].

The aim of this study was to investigate the safety and efficacy of endoscopic temporary placement of a biliary CSEMS in the treatment of complex bile leaks.

1 This work was presented in part at the annual meeting of the American Society of Gastrointestinal Endoscopy, Digestive Diseases Week, May 17 to 22, 2008, San Diego, Calif., USA. Abstract was published in Gastrointest Endosc 2008; 67: AB162.

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1 This work was presented in part at the annual meeting of the American Society of Gastrointestinal Endoscopy, Digestive Diseases Week, May 17 to 22, 2008, San Diego, Calif., USA. Abstract was published in Gastrointest Endosc 2008; 67: AB162.

M. KahalehMD 

Digestive Health Center of Excellence
Division of Gastroenterology and Hepatology

Box 800708
University of Virginia Health System
Charlottesville
VA 22908
USA

Email: mk5ke@virginia.edu