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Removable Biliary Stent-Grafts Have High Success Rate

May 13, 2009
Written by: , Filed in: Interventional Radiology
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Benign biliary strictures are a difficult management problem and notoriously hard to fix.

The most efficacious way to fix this problem is surgical revision, but many will experience further problems with strictures.

Endoscopic treatment and placement of plastic stents is not optimal, because these stents tend to occlude and migrate.

Metallic stents almost always eventually occlude, as do permanent stent-grafts.

The percutaneous transhepatic approaches with balloon dilation, with or without the long-term placement of external tubes, has been widely practiced, with a primary patency rate of up to 73 % to as low as 42%.

The objective of a recent study was to refine the use of retrievable stent-grafts to achieve better long-term patency.

Methodology
Over 2 years, 29 patients with 32 benign biliary strictures were enrolled in a nonrandomized, prospective study involving the use of removable biliary stent-grafts.
Patients were divided into 2 groups:

  1. the post surgical stricture group;
  2. the chronic cholangitis group.

The stent-graft used was a nitinol self-expanding stent covered in polytetrafluoroethylene on the outside.

Within the end of the stent was a nylon drawstring apparatus that would allow the stent to be collapsed and pulled out of the biliary system with the use of a specially made hook wire.

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review

Results
The mean diameter of the strictures was 1.2 mm before attempting balloon dilation, and 1.9 mm after dilation.

The stent-grafts were removed after a mean of 6.7 weeks. The mean diameter of the treated strictures was 6.7 mm immediately after removal of the stent-graft and 6.0 mm after 3 to 8 weeks.

In 3 patients, strictures recurred within 2 weeks, necessitating repeat stent placement.

All of these patients were followed-up for mean up to 28 months without recurrent stricture.

In only 1 patient was there stricture unresponsive to stent-graft placement, even after 30 weeks of therapy.

The primary patency rate was 90.6% overall, 88% for the chronic cholangitis group, and 93% for the postoperative stricture group. There was a 96% secondary patency clinical success rate.

Complications
Hemobilia and mild cholangitis occurred, and were associated with initial instrumentation. There were no major complications associated with stent placement. The migration rate was 11%.

Conclusions
Preliminary data show that removable stent-grafts are an excellent treatment for benign biliary strictures.

Reviewer’s Comments
The use of removable biliary stent-grafts allows for adequate internal drainage while allowing treatment of benign biliary strictures.

This study recommends that the stent-grafts be removed after 6 weeks and the biliary catheter after 2 weeks.

In conclusion, the results of this initial study on removable stent-grafts to treat benign biliary strictures is very encouraging, showing an overall clinical success rate of 97%.

Author: Sharon Gonzales, MD

Gwon DI, Shim HJ, Kwak BK. Retrievable Biliary Stent-Graft in the Treatment of Benign Biliary Strictures. J Vasc Interv Radiol; 2008; 19 (September): 1328-1335

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review
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