Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos)

BackgroundComplex biliary stones often require temporary stent placement before a repeat attempt at extraction. To date, covered self-expandable metal stents (CSEMSs) have not been formally investigated for this indication.ObjectiveTo evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones.DesignRetrospective case series.SettingLarge quaternary-care center.PatientsThirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy.InterventionsPatients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction.Main Outcome MeasurementsSuccess achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed.ResultsCSEMS placement was successful in establishing immediate biliary drainage in all 36 patients. Complete duct clearance at repeat ERC was achieved in 29 of 35 patients after a mean duration of 6.4 weeks. Four of the remaining 6 patients underwent sequential CSEMS placement, with eventual duct clearance after multiple ERCPs. There were no complications related to biliary obstruction. One patient died of a nonbiliary cause. Of the total 42 CSEMSs placed, there were 4 cases (9.5%) of clinically insignificant stent migration.LimitationsSingle-center experience, retrospective design.ConclusionsCSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.