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

BACKGROUND: Complex 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.

OBJECTIVE: To evaluate the efficacy and safety of CSEMSs in patients with retained complex biliary stones.

DESIGN: Retrospective case series.

SETTING: Large quaternary-care center.

PATIENTS: Thirty-six patients (24 women) with complex biliary stones with incomplete stone clearance after endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy.

INTERVENTIONS: Patients with incomplete stone clearance after ERC with biliary sphincterotomy underwent temporary placement of CSEMSs, with subsequent removal before repeat stone extraction.

MAIN OUTCOME MEASUREMENTS: Success achieving immediate biliary drainage and eventual complete duct clearance. Procedure-related complications were also assessed.

RESULTS: CSEMS 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.

LIMITATIONS: Single-center experience, retrospective design.

CONCLUSIONS: CSEMSs permit management of complex biliary stones, but require multiple sessions. The cost-effectiveness of this technique needs further investigation.