Temporäre Metall Stents zur Therapie benigner Gallengangsläsionen

Zusammenfassung

Wir untersuchten die Sicherheit, den klinischen Erfolg und die Komplikationsrate von komplett beschichteten Metallstents (fcSEMS) bei 36 Patienten mit benignen biliären Stenosen und Leckagen und erfolgloser konventioneller endoskopischer Therapie. Die Indikation zur Implantation war eine biliäre Läsion nach Lebertransplantation (n = 23), Leberresektion (n = 6), Cholezystektomie (n = 2), chronischen Pankreatitis (n = 2), iatrogener Perforation nach ERC (n = 3).

Die Platzierung und Entfernung der fcSEMS gelang ohne Komplikationen. Bei 30 Patienten konnte die Therapie (Therapiedauer im Mittel 13 Wo.) abgeschlossen werden. Die Erfolgsrate bezogen auf alle Patienten lag bei 69 %, bezogen auf die Patienten, die die Therapie abschließen konnten bei 83 %. Bei den Patienten ohne therapeutischen Erfolg war eine chirurgische Revision bzw. Retransplantation erforderlich. Insgesamt wurden bei 14 Patienten Komplikationen beobachtet. Dies entspricht einer Komplikationsrate von 39 %. Die interventionspflichtige Komplikationsrate lag bei 14 %.

Komplett beschichtete, temporär eingesetzte Metallstents sind in der endoskopischen Therapie benigner Gallengangsstenosen und -leckagen eine Erweiterung des therapeutischen Spektrums mit akzeptabler Komplikationsrate. Falls die konventionelle endoskopische Therapie keinen Erfolg bringt, könnten sich diese Stents zumindest bei biliären Komplikationen nach Lebertransplantation und akuten Gallengangsverletzungen als eine Alternative zur chirurgischen Intervention etablieren. Eine Evaluierung als primäre endoskopische Therapie bei definierten Indikationen erscheint in prospektiven Studien gerechtfertigt.

Abstract

In the present study we evaluated safety, efficacy and complications of temporary fully-covered, self-expandable metal stents (fcSEMS) in 36 patients with benign biliary strictures and leakage that failed after standard endoscopic procedures. Indication for fcSEMS was biliary lesions after liver transplantation (n = 23), partial liver resection (n = 6), cholezystectomy (n = 2), chronic pancreatitis (n = 2) and common duct injury after ERC (n = 3).

Placement of fcSEMS and removal in scheduled patients was successful and without complications. Treatment was completed in 30 patients after a mean of 13 weeks. Success rate concerning all patients was 69 %, concerning only patients with completed treatment it was 83 %. In patients without therapeutic success surgical reintervention or retransplantation was required. An overall complication rate of 39 % (14 patients) was noted, but an intervention was required in only 5 patients resulting in a complication rate of 14 %.

Temporary placement of fcSEMS in benign biliary strictures and leaks offers an extension of therapeutic options with satisfactory results and acceptable complication rate. At least in patients with biliary lesions after liver transplantation or acute biliary injury and failure of standard endoscopic treatment fcSEMS may become an alternative approach to surgical intervention. Prospective trials evaluating temporary placement of fcSEMS as first line approach seems justified.

Schlüsselwörter

benigne biliäre Stenosen - biliäre Leckage - selbstexpandierende Metallstents - beschichtete Gallengangstents - ERCP

Key words

benign biliary strictures - biliary leakage - self expandable metal stents - coated biliary stents - ERCP

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