ArticleEndoscopy international open2025
Fully-covered metal stent removal failure in case of non-malignant biliary strictures: Risk factors and resolution technique.
Article in Endoscopy international open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Background and study aims: Fully-covered-self-expandable-metal-stents (FC-SEMS) are commonly used for non-malignant biliary stricture treatment. Removal failure related to hyperplastic tissue development over the distal margin of the stent has been described but few data are available. FC-SEMS-in-FC-SEMS technique has been described in case reports to overcome FC-SEMS removal failure. Aims of this study were investigating technical success, clinical success, and safety of the FC-SEMS-in-FC-SEMS technique and identification of risk factors for FC-SEMS removal failure in patients with non-malignant distal biliary stricture. Patients and methods: Endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 1, 2020 and May 31, 2023 for FC-SEMS removal in non-malignant distal biliary strictures were retrospectively identified and analyzed. Cases of FC-SEMS-in-FC-SEMS technique were evaluated. Results: FC-SEMS-in-FC-SEMS technique was used in 15 patients. FC-SEMS removal was achieved after a single treatment in 13 patients (86.7%). In the remaining two patients (13.3%), it was necessary to repeat treatment to achieve FC-SEMS removal, with an overall technical and clinical success of 100%. No significant adverse events were recorded. Among the 50 patients undergoing ERCP for FC-SEMS removal during the study period (median dwell stenting period of 306.5 days; Q1-Q3:160-392), failure was observed in 15 cases (30%). Previous biliary stenting and dwell stenting period > 300 days were identified as risk factors for FC-SEMS removal failure. Conclusions: FC-SMES-in-FC-SEMS technique appears to be safe and effective to overcome FC-SEMS removal failure in patients with non-malignant distal biliary strictures. Reducing dwell stenting period, especially in patients with personal history of previous biliary stenting, may reduce risk of FC-SEMS removal failure.
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