Pseudoaneurysms Post-biliary Stenting: A Comprehensive Literature Review.

Area of Science:

• Gastroenterology
• Interventional Radiology
• Oncology

Background:

• Pseudoaneurysms (PSA) are rare but life-threatening complications of endoscopic biliary stenting.
• The incidence, diagnosis, treatment, and prevention of these pseudoaneurysms are not well-established.

Purpose of the Study:

• To evaluate the association between biliary stent placement and the development of pseudoaneurysms.
• To review the incidence, diagnostic methods, treatment strategies, and outcomes of pseudoaneurysms following biliary stenting.

Main Methods:

• A comprehensive literature search was conducted across multiple databases.
• Studies reporting pseudoaneurysms after biliary stent placement were included, with data extraction following PRISMA guidelines.

Main Results:

• 32 studies (36 patients) met inclusion criteria. Most patients had stents in the common bile duct for pancreatic adenocarcinoma.
• Gastrointestinal bleeding (75%) was the most common symptom, with pseudoaneurysms often located in the hepatic artery (55.6%).
• Diagnostic angiography (55.6%) and embolization (86.1%) were the primary diagnostic and treatment modalities. Most patients recovered fully.

Conclusions:

• Pseudoaneurysms post-biliary stenting frequently present with gastrointestinal bleeding.
• Patients with metal stents for pancreaticobiliary malignancy, and prior chemotherapy/radiation, are at higher risk.
• Angiography and embolization are key for diagnosis and management.