USEFULNESS OF UNFLARED INTRADUCTAL SHORT FULLY COVERED SELF-EXPANDABLE METALLIC STENT FOR ENDOSCOPIC REMOVAL OF BILE DUCT STONES COMPLICATED BY BILIARY STRICTURE

Abstract

Background and Aims Endoscopic management of complicated bile duct stones in patients with benign biliary stricture (BBS) is very challenging. Recently developed modified short length of fully covered self-expandable metallic stent (FCSEMS) can be inserted intraductally and easily removed by long lasso. Our aim was to evaluate the usefulness of short intraductal FCSEMS for endoscopic removal of complicated bile duct stones after relieving of biliary stricture. Methods Twenty-six patients (11 women; median age, 61.5 years [range, 23-84]) having retained bile duct stones with biliary stricture failed by conventional endoscopic removal included this study. Non-flared short FCSEMS (BONASTENT M-Intraductal®, Standard Sci-Tech Inc, Korea) having 7 or 10 cm of lasso was intraductally inserted on stricture. After FCSEMS removal at 6months stenting period, endoscopic stone removal was tried. Primary outcome was complete stone clearance rate. Secondary outcomes were success rate of stent insertion and removal, relieving of biliary stricture rate, and procedure-related adverse events. Results Intraductal placement of FCSEMS was successful in all cases. There were 3 cases (11.5 %) of stent migration during follow up. Intended stent removal was successful in other 23 patients. Improvement of biliary stricture revealed in all 26 patients. Complete stone clearance was achieved 25 of 26 patients (96.2%). There was no significant adverse event related to procedures. No stent-induced ductal change was observed in all patients. Conclusion Temporary intraductal placement of unflared FCSEMS may be an effective in endoscopic management of complicated bile duct stones in patients with biliary stricture minimizing stent induced adverse events.