Kaplan-Meier-plot of estimated stent patency

Long-Term Outcome of Self Expandable Metal Stents for Biliary Obstruction in Chronic Pancreatitis

Alexander Waldthaler, Kerstin Schütte, Jochen Weigt, Siegfried Kropf, Peter Malfertheiner, Stefan Kahl


Context Insertion of a self-expandable metal stent is still controversial for treatment of benign common bile duct stenosis but can be a valuable alternative to surgical treatment. Objective Aim of our study was to analyze the efficacy of covered and uncovered self-expandable metal stent in patients with chronic pancreatitis and common bile duct stenosis. Material and methods Twenty patients with common bile duct stenosis due to alcoholic chronic pancreatitis were retrospective analyzed. All patients had advanced chronic pancreatitis, presenting with calcifications in pancreatic head. Uncovered self-expandable metal stent (uSEMS) were used in 11 patients (3 females, 8 males) while in 9 patients (3 females, 6 males) partially covered self-expandable metal stent (cSEMS) were inserted. All patients treated with self-expandable metal stent had contraindications for surgery. Results Overall mean follow up time was 155 weeks: 206 (52-412) weeks in uSEMS, and 93 (25-233) weeks in cSEMS, respectively. Stent patency was in mean 118 weeks: 159 (44-412) weeks in uSEMS and 67 (25-150) weeks in cSEMS (P=0.019). In the uSEMS group, reintervention was necessary in 5 patients (45%) due to stent obstruction, whereas in the cSEMS group 4 patients (44%) needed reintervention (2 obstructions, 2 migration). Stent migration is an early complication, compared to obstruction (P<0.05), and in cSEMS obstruction occurred significantly earlier compared to uSEMS (P<0.05). Conclusion Patency of uSEMS was significantly longer compared to partially cSEMS. Available self-expandable metal stent, unfortunately, do not meet the demands on successful treatment of benign common bile duct stenosis.

Image: Kaplan-Meier-plot of estimated stent patency.


Endoscopy; Pancreatitis, Chronic; Stents

Full Text:



Apte, M. V., Pirola, R. C., Wilson, J. S. Mechanisms of alcoholic pancreatitis. J.Gastroenterol.Hepatol. 2010; 25:12, 1816-1826.

Scott, J., Summerfield, J. A., Elias, E. et al. Chronic pancreatitis: a cause of cholestasis. Gut 1977; 18:3, 196-201.

Abdallah, A. A., Krige, J. E., Bornman, P. C. Biliary tract obstruction in chronic pancreatitis. HPB (Oxford) 2007; 9:6, 421-428.

Eickhoff, A., Jakobs, R., Leonhardt, A. et al. Endoscopic stenting for common bile duct stenoses in chronic pancreatitis: results and impact on long-term outcome. Eur.J.Gastroenterol.Hepatol. 2001; 13:10, 1161-1167.

van Boeckel, P. G., Vleggaar, F. P., Siersema, P. D. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC.Gastroenterol. 2009; 9: 96.

Buchler, M. W. and Warshaw, A. L. Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology 2008; 134:5, 1605-1607.

Hakaim, A. G., Broughan, T. A., Vogt, D. P. et al. Long-term results of the surgical management of chronic pancreatitis. Am.Surg. 1994; 60:5, 306-308.

Beger, H. G., Schlosser, W., Friess, H. M. et al. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann.Surg. 1999; 230:4, 512-519.

van Berkel, A. M., Cahen, D. L., van Westerloo, D. J. et al. Self-expanding metal stents in benign biliary strictures due to chronic pancreatitis. Endoscopy 2004; 36:5, 381-384.

Deviere, J., Devaere, S., Baize, M. et al. Endoscopic biliary drainage in chronic pancreatitis. Gastrointest.Endosc. 1990; 36:2, 96-100.

Libby, E. D. and Leung, J. W. Prevention of biliary stent clogging: a clinical review. Am.J.Gastroenterol. 1996; 91:7, 1301-1308.

Huibregtse, K., Carr-Locke, D. L., Cremer, M. et al. Biliary stent occlusion--a problem solved with self-expanding metal stents? European Wallstent Study Group. Endoscopy 1992; 24:5, 391-394.

Bergman, J. J., Burgemeister, L., Bruno, M. J. et al. Long-term follow-up after biliary stent placement for postoperative bile duct stenosis. Gastrointest.Endosc. 2001; 54:2, 154-161.

Bilbao, M. K., Dotter, C. T., Lee, T. G. et al. Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology 1976; 70:3, 314-320.

Kahl, S., Zimmermann, S., Genz, I. et al. Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am.J.Gastroenterol. 2003; 98:11, 2448-2453.

Smits, M. E., Rauws, E. A., van Gulik, T. M. et al. Long-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis. Br.J.Surg. 1996; 83:6, 764-768.

Cahen, D. L., van Berkel, A. M., Oskam, D. et al. Long-term results of endoscopic drainage of common bile duct strictures in chronic pancreatitis. Eur.J.Gastroenterol.Hepatol. 2005; 17:1, 103-108.

Catalano, M. F., Linder, J. D., George, S. et al. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest.Endosc. 2004; 60:6, 945-952.

Monkemuller, K. E., Kahl, S., Malfertheiner, P. Endoscopic therapy of chronic pancreatitis. Dig.Dis. 2004; 22:3, 280-291.

Irving, J. D., Adam, A., Dick, R. et al. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology 1989; 172:2, 321-326.

Isayama, H., Komatsu, Y., Tsujino, T. et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest.Endosc. 2002; 55:3, 366-370.

Fumex, F., Coumaros, D., Napoleon, B. et al. Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy 2006; 38:8, 787-792.

Kullman, E., Frozanpor, F., Soderlund, C. et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest.Endosc. 2010; 72:5, 915-923.

Loew, B. J., Howell, D. A., Sanders, M. K. et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest.Endosc. 2009; 70:3, 445-453.

Bakhru, M., Ho, H. C., Gohil, V. et al. Fully Covered Self Expandable Metal Stents (CSEMS) in Malignant Distal Biliary Strictures: Mid-Term Evaluation. J.Gastroenterol.Hepatol. 8-2-2011;

Cahen, D. L., Rauws, E. A., Gouma, D. J. et al. Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy 2008; 40:8, 697-700.

Mahajan, A., Ho, H., Sauer, B. et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video). Gastrointest.Endosc. 2009; 70:2, 303-309.

Weickert, U., Wiesend, F., Subkowski, T. et al. Optimizing biliary stent patency by coating with hydrophobin alone or hydrophobin and antibiotics or heparin: an in vitro proof of principle study. Adv.Med.Sci. 2011; 56:2, 138-144.

Guaglianone, E., Cardines, R., Vuotto, C. et al. Microbial biofilms associated with biliary stent clogging. FEMS Immunol.Med.Microbiol. 2010; 59:3, 410-420.

Hoffmeister A, Mayerle J, Beglinger C, et al. S3-Consensus Guidelines on Definition, Etiology, Diagnosis and Medical, Endoscopic and Surgical Management of Chronic Pancreatitis German Society of Digestive and Metabolic Diseases (DGVS)]. Z Gastroenterol. 2012 Nov;50(11):1176-224.

DOI: http://dx.doi.org/10.6092/1590-8577/870

NBN: http://nbn.depositolegale.it/urn%3Anbn%3Ait%3Aunina-16206


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 1590-8577 | JOP is published by CAB - Center for Libraries at "Federico II" University of Naples using Open Journal System