Fully covered self-expandable metallic stents in benign biliary strictures: A multicenter study on efficacy and safety

I. Tarantino, B. Mangiavillano, R. Di Mitri, L. Barresi, F. Mocciaro, A. Granata, E. Masci, G. Curcio, M. Di Pisa, A. Marino, M. Traina

Research output: Contribution to journalArticle

Abstract

Background and study aim: Benign biliary diseases include benign biliary stricture (BBS), lithiasis, and leaks. BBSs are usually treated with plastic stent placement; use of uncovered or partially covered metallic stents has been associated with failure related to mucosal hyperplasia. Some recently published series suggest the efficacy of fully covered self-expandable metal stents (FCSEMSs) in BBS treatment. We aimed to assess the efficacy and safety of FCSEMS in a large series of patients with BBS and a long follow-up. Patients and methods: Prospective multicenter clinical study at three tertiary referral centers: ISMETT/UPMC Italy, Palermo, San Paolo Hospital, Milan, and the ARNAS Civico Hospital, Palermo, Italy. All consecutive patients with BBS were treated with placement of FCSEMS rather than plastic stents, as first approach (11 patients, 17.7%), or as a second approach after failure of other treatments (51 patients, 82.2%). Results: From January 2008 to March 2011, 62 patients (40 male) were included. Mean period of FCSEMS indwelling was 96.7 days (standard deviation [SD] 6.5 days). In 15 patients (24.2%) the SEMS migrated. Resolution of BBS occurred in 56 patients (90.3%), while in 6 (9.6%) the treatment failed. Mean (SD) follow-up after SEMS removal was 15.9 (10) months. FCSEMS placement as first- or second-line approach showed no difference in failure. Recurrence was observed in 4/56 patients (7.1%); all were transplant recipients: P=0.01; odds ratio (OR) 1.2, confidence interval (CI) 1.1-1.3. Conclusions: Despite the noteworthy migration rate, FCSEMSs should be considered effective for refractory benign biliary strictures. Further studies are needed to assess their role as a first approach in the management of BBS.

Original languageEnglish
Pages (from-to)923-927
Number of pages5
JournalEndoscopy
Volume44
Issue number10
DOIs
Publication statusPublished - 2012

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Multicenter Studies
Pathologic Constriction
Safety
Stents
Italy
Plastics
Self Expandable Metallic Stents
Lithiasis
Treatment Failure
Tertiary Care Centers
Hyperplasia
Odds Ratio
Confidence Intervals
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

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Fully covered self-expandable metallic stents in benign biliary strictures : A multicenter study on efficacy and safety. / Tarantino, I.; Mangiavillano, B.; Di Mitri, R.; Barresi, L.; Mocciaro, F.; Granata, A.; Masci, E.; Curcio, G.; Di Pisa, M.; Marino, A.; Traina, M.

In: Endoscopy, Vol. 44, No. 10, 2012, p. 923-927.

Research output: Contribution to journalArticle

Tarantino, I. ; Mangiavillano, B. ; Di Mitri, R. ; Barresi, L. ; Mocciaro, F. ; Granata, A. ; Masci, E. ; Curcio, G. ; Di Pisa, M. ; Marino, A. ; Traina, M. / Fully covered self-expandable metallic stents in benign biliary strictures : A multicenter study on efficacy and safety. In: Endoscopy. 2012 ; Vol. 44, No. 10. pp. 923-927.
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abstract = "Background and study aim: Benign biliary diseases include benign biliary stricture (BBS), lithiasis, and leaks. BBSs are usually treated with plastic stent placement; use of uncovered or partially covered metallic stents has been associated with failure related to mucosal hyperplasia. Some recently published series suggest the efficacy of fully covered self-expandable metal stents (FCSEMSs) in BBS treatment. We aimed to assess the efficacy and safety of FCSEMS in a large series of patients with BBS and a long follow-up. Patients and methods: Prospective multicenter clinical study at three tertiary referral centers: ISMETT/UPMC Italy, Palermo, San Paolo Hospital, Milan, and the ARNAS Civico Hospital, Palermo, Italy. All consecutive patients with BBS were treated with placement of FCSEMS rather than plastic stents, as first approach (11 patients, 17.7{\%}), or as a second approach after failure of other treatments (51 patients, 82.2{\%}). Results: From January 2008 to March 2011, 62 patients (40 male) were included. Mean period of FCSEMS indwelling was 96.7 days (standard deviation [SD] 6.5 days). In 15 patients (24.2{\%}) the SEMS migrated. Resolution of BBS occurred in 56 patients (90.3{\%}), while in 6 (9.6{\%}) the treatment failed. Mean (SD) follow-up after SEMS removal was 15.9 (10) months. FCSEMS placement as first- or second-line approach showed no difference in failure. Recurrence was observed in 4/56 patients (7.1{\%}); all were transplant recipients: P=0.01; odds ratio (OR) 1.2, confidence interval (CI) 1.1-1.3. Conclusions: Despite the noteworthy migration rate, FCSEMSs should be considered effective for refractory benign biliary strictures. Further studies are needed to assess their role as a first approach in the management of BBS.",
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T1 - Fully covered self-expandable metallic stents in benign biliary strictures

T2 - A multicenter study on efficacy and safety

AU - Tarantino, I.

AU - Mangiavillano, B.

AU - Di Mitri, R.

AU - Barresi, L.

AU - Mocciaro, F.

AU - Granata, A.

AU - Masci, E.

AU - Curcio, G.

AU - Di Pisa, M.

AU - Marino, A.

AU - Traina, M.

PY - 2012

Y1 - 2012

N2 - Background and study aim: Benign biliary diseases include benign biliary stricture (BBS), lithiasis, and leaks. BBSs are usually treated with plastic stent placement; use of uncovered or partially covered metallic stents has been associated with failure related to mucosal hyperplasia. Some recently published series suggest the efficacy of fully covered self-expandable metal stents (FCSEMSs) in BBS treatment. We aimed to assess the efficacy and safety of FCSEMS in a large series of patients with BBS and a long follow-up. Patients and methods: Prospective multicenter clinical study at three tertiary referral centers: ISMETT/UPMC Italy, Palermo, San Paolo Hospital, Milan, and the ARNAS Civico Hospital, Palermo, Italy. All consecutive patients with BBS were treated with placement of FCSEMS rather than plastic stents, as first approach (11 patients, 17.7%), or as a second approach after failure of other treatments (51 patients, 82.2%). Results: From January 2008 to March 2011, 62 patients (40 male) were included. Mean period of FCSEMS indwelling was 96.7 days (standard deviation [SD] 6.5 days). In 15 patients (24.2%) the SEMS migrated. Resolution of BBS occurred in 56 patients (90.3%), while in 6 (9.6%) the treatment failed. Mean (SD) follow-up after SEMS removal was 15.9 (10) months. FCSEMS placement as first- or second-line approach showed no difference in failure. Recurrence was observed in 4/56 patients (7.1%); all were transplant recipients: P=0.01; odds ratio (OR) 1.2, confidence interval (CI) 1.1-1.3. Conclusions: Despite the noteworthy migration rate, FCSEMSs should be considered effective for refractory benign biliary strictures. Further studies are needed to assess their role as a first approach in the management of BBS.

AB - Background and study aim: Benign biliary diseases include benign biliary stricture (BBS), lithiasis, and leaks. BBSs are usually treated with plastic stent placement; use of uncovered or partially covered metallic stents has been associated with failure related to mucosal hyperplasia. Some recently published series suggest the efficacy of fully covered self-expandable metal stents (FCSEMSs) in BBS treatment. We aimed to assess the efficacy and safety of FCSEMS in a large series of patients with BBS and a long follow-up. Patients and methods: Prospective multicenter clinical study at three tertiary referral centers: ISMETT/UPMC Italy, Palermo, San Paolo Hospital, Milan, and the ARNAS Civico Hospital, Palermo, Italy. All consecutive patients with BBS were treated with placement of FCSEMS rather than plastic stents, as first approach (11 patients, 17.7%), or as a second approach after failure of other treatments (51 patients, 82.2%). Results: From January 2008 to March 2011, 62 patients (40 male) were included. Mean period of FCSEMS indwelling was 96.7 days (standard deviation [SD] 6.5 days). In 15 patients (24.2%) the SEMS migrated. Resolution of BBS occurred in 56 patients (90.3%), while in 6 (9.6%) the treatment failed. Mean (SD) follow-up after SEMS removal was 15.9 (10) months. FCSEMS placement as first- or second-line approach showed no difference in failure. Recurrence was observed in 4/56 patients (7.1%); all were transplant recipients: P=0.01; odds ratio (OR) 1.2, confidence interval (CI) 1.1-1.3. Conclusions: Despite the noteworthy migration rate, FCSEMSs should be considered effective for refractory benign biliary strictures. Further studies are needed to assess their role as a first approach in the management of BBS.

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