A US Multicenter Study of Safety and Efficacy of Fully Covered Self-Expandable Metallic Stents in Benign Extrahepatic Biliary Strictures

Background: Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges. Aims: The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS. Methods: A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded. Results: A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57 % were males. Stricture resolution occurred in 81 % of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7 %) was the most common complication, followed by stent occlusion (4.9 %), cholangitis (4.1 %), and pancreatitis (3.3 %). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis. Conclusions: Majority of BBS can be successfully managed with 1–2 consecutive FCSEMS with stent dwell time of 6 months.