Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data - a case...

Techniques for management of bile leaks include biliary sphincterotomy and stenting. Partially covered self-expandable metallic stents have been used in complex bile leaks, but they are associated with migration and hyperplasia. A fully covered self-expandable metallic stent (CSEMS) with anchoring fins might be effective in treating bile leaks without these complications. The aim of this study was to investigate the safety and efficacy of temporary placement of a CSEMS for resolving complex bile leaks. Thirteen patients with complex bile leaks underwent endoscopic retrograde cholangiopancreatography (ERCP) with temporary placement of a CSEMS following cholecystectomy (n = 8) or liver transplantation (n = 5). All patients had resolution of their bile leaks. Two patients developed a stricture below the confluence. Three patients died from unrelated causes. Two deaths occurred prior to CSEMS removal. Ten of 11 patients had evidence of biliary debris at the time of CSEMS removal. Overall, temporary placement of CSEMS is efficacious atresolving bile leaks. CSEMS are less prone to migration, but are associated with ulcerations, de novo choledocholithiasis, and strictures.