Long-term outcomes after temporary placement of a self-expanding fully covered metal stent for benign biliary strictures secondary to chronic pancreatitis

• Published in: Gastrointestinal endoscopy Vol. 91; no. 2; pp. 361 - 369.e3
• Main Authors: Lakhtakia, Sundeep, Reddy, Nageshwar, Dolak, Werner, Ponchon, Thierry, Bruno, Marco J., Bourke, Michael J., Neuhaus, Horst, Roy, André, González-Huix Lladó, Ferrán, Kortan, Paul P., Peetermans, Joyce, Rousseau, Matthew, Costamagna, Guido, Devière, Jacques, Williams, Stephen J., Püspök, Andreas, Tribl, Barbara, Blero, Daniel, Huberty, Vincent, Delhaye, Myriam, Lemmers, Arnaud, Le Moine, Olivier, Arvanitakis, Marianna, Plasse, Marylène, May, Gary, Lepilliez, Vincent, Schumacher, Brigitte, Charton, Jean Pierre, Gerges, Christian, Beyna, Torsten, Reddy, D. Nageshwar, Tringali, Andrea, Perri, Vincenzo, Familiari, Pietro, Mutignani, Massimiliano, Poley, Jan W., Fransech, Montserrat Figa, Bowman, Thomas, Carr-Locke, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2020
• Subjects: Adult; Bile Duct Diseases - etiology; Bile Duct Diseases - therapy; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis - epidemiology; Cholestasis - etiology; Cholestasis - therapy; Constriction, Pathologic - etiology; Constriction, Pathologic - therapy; Device Removal; Female; Humans; Male; Middle Aged; Pancreatitis, Chronic - complications; Postoperative Complications - epidemiology; Recurrence; Self Expandable Metallic Stents; Treatment Outcome; MPS; BBS; CI; SAE; HR; IQR; CDM; CP; FCSEMS
• ISSN: 0016-5107; 1097-6779; 1085-8741; 1097-6779
• DOI: 10.1016/j.gie.2019.08.037

Temporary single, fully covered self-expanding metal stent (FCSEMS) placement for benign biliary strictures (BBSs) associated with chronic pancreatitis (CP) may require fewer interventions than endotherapy with multiple plastic stents and may carry less morbidity than biliary diversion surgery. This study aimed to assess long-term outcomes in CP-associated BBSs after FCSEMS placement and removal. In this open-label, multinational, prospective study, subjects with CP and a BBS treated with FCSEMS placement with scheduled removal at 10 to 12 months were followed for 5 years after FCSEMS indwell. Kaplan-Meier analyses assessed BBS resolution and cumulative probability of freedom from recurrent stent placement to 5 years after FCSEMS indwell. One hundred eighteen patients were eligible for FCSEMS removal. At a median of 58 months (interquartile range, 44-64) post-FCSEMS indwell, the probability of remaining stent-free was 61.6% (95% confidence interval [CI], 52.5%-70.7%). In 94 patients whose BBSs resolved at the end of FCSEMS indwell, the probability of remaining stent-free 5 years later was 77.4% (95% CI, 68.4%-86.4%). Serious stent-related adverse events occurred in 27 of 118 patients (22.9%); all resolved with medical therapy or repeated endoscopy. Multivariate analysis identified severe CP (hazard ratio, 2.4; 95% CI, 1.0-5.6; P = .046) and longer stricture length (hazard ratio, 1.2; 95% CI, 1.0-1.4; P = .022) as predictors of stricture recurrence. In patients with symptomatic BBSs secondary to CP, 5 years after placement of a single FCSEMS intended for 10 to 12 months indwell, more than 60% remained asymptomatic and stent-free with an acceptable safety profile. Temporary placement of a single FCSEMS may be considered as first-line treatment for patients with CP and BBSs. (Clinical trial registration number: NCT 01014390.) [Display omitted]