Endoscopy 2009; 41(6): 547-551
DOI: 10.1055/s-0029-1214708
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis

B.  Behm1 , A.  Brock1 , B.  W.  Clarke1 , K.  Ellen1 , P.  G.  Northup1 , J.  M.  Dumonceau2 , M.  Kahaleh1
  • 1Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia, USA
  • 2Gastroenterology, University Hospital of Geneva, Geneva, Switzerland
Further Information

Publication History

submitted 22 February 2008

accepted after revision 16 March 2009

Publication Date:
16 June 2009 (online)

Background and study aims: Benign biliary strictures (BBS) may occur in patients with chronic pancreatitis and may lead to secondary biliary cirrhosis or recurrent cholangitis. Although surgical diversion may provide definitive therapy, it can be associated with significant morbidity. Endoscopic therapy with plastic stents has been used as an alternative to surgery but has resulted in unsatisfactory long-term outcomes. We evaluated the temporary placement of partially covered self-expandable metallic stents (PCMS) in patients with BBS due to chronic pancreatitis.

Patients and methods: A total of 20 patients with BBS due to chronic pancreatitis underwent temporary placement of PCMS over a 6-year period. The primary outcome of interest was the proportion of patients with stricture resolution persisting 6 months after stent removal. Secondary outcomes included the stent failure rate, number of endoscopic sessions required to achieve biliary drainage, total duration of stenting, and complication rate.

Results: Adequate biliary drainage was achieved in 19 patients with PCMS (95 %). Eighteen of the 20 patients (90 %) had persistent stricture resolution 6 months after PCMS removal. In two of the 20 patients (10 %), PCMS stenting failed and these patients underwent alternative therapies. Complications occurred in four patients (20 %). Median duration of PCMS placement was 5 months, requiring a median of two endoscopic procedures.

Conclusion: In this series of patients with BBS due to chronic pancreatitis, temporary PCMS placement achieved persistent stricture resolution in the majority of patients with acceptable complication rates. Comparative trials evaluating temporary PCMS placement and plastic stenting in patients with BBS due to chronic pancreatitis are needed.


  • 1 Adler D G, Lichtenstein D, Baron T H. et al . The role of endoscopy in patients with chronic pancreatitis.  Gastrointest Endosc. 2006;  63 933-937
  • 2 Nealon W H, Urrutia F. Long-term follow-up after bilioenteric anastomosis for benign bile duct stricture.  Ann Surg. 1996;  223 639-645 [discussion 645 – 648]
  • 3 Frattaroli F M, Reggio D, Guadalaxara A. et al . Benign biliary strictures: a review of 21 years of experience.  J Am Coll Surg. 1996;  183 506-513
  • 4 Stahl T J, Allen M O, Ansel H J, Vennes J A. Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage.  Ann Surg. 1988;  207 26-32
  • 5 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;  83 764-768
  • 6 Deviere J, Cremer M, Baize M. et al . Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents.  Gut. 1994;  35 122-126
  • 7 Deviere J, Devaere S, Baize M, Cremer M. Endoscopic biliary drainage in chronic pancreatitis.  Gastrointest Endosc. 1990;  36 96-100
  • 8 Vitale G C, Reed Jr. D N, Nguyen C T. et al . Endoscopic treatment of distal bile duct stricture from chronic pancreatitis.  Surg Endosc. 2000;  14 227-231
  • 9 Farnbacher M J, Rabenstein T, Ell C. et al . Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis up-to-date?.  Am J Gastroenterol. 2000;  95 1466-1471
  • 10 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 1161-1167
  • 11 Kiehne K, Folsch U R, Nitsche R. High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance.  Endoscopy. 2000;  32 377-380
  • 12 Barthet M, Bernard J P, Duval J L. et al . Biliary stenting in benign biliary stenosis complicating chronic calcifying pancreatitis.  Endoscopy. 1994;  26 569-572
  • 13 Draganov P, Hoffman B, Marsh W. et al . Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents.  Gastrointest Endosc. 2002;  55 680-686
  • 14 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;  60 945-952
  • 15 Lee J G, Leung J W. Biliary stents – plastic or metal?.  Gastrointest Endosc. 1998;  47 90-91
  • 16 Wadhwa R P, Kozarek R A, France R E. et al . Use of self-expandable metallic stents in benign GI diseases.  Gastrointest Endosc. 2003;  58 207-212
  • 17 Faigel D O. Preventing biliary stent occlusion.  Gastrointest Endosc. 2000;  51 104-107
  • 18 Dumonceau J M, Deviere J, Delhaye M. et al . Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst.  Gastrointest Endosc. 1998;  47 8-17
  • 19 Isayama H, Komatsu Y, Tsujino T. et al . A prospective randomised study of ”covered” versus ”uncovered” diamond stents for the management of distal malignant biliary obstruction.  Gut. 2004;  53 729-734
  • 20 Kahaleh M, Tokar J, Conaway M R. et al . Efficacy and complications of covered Wallstents in malignant distal biliary obstruction.  Gastrointest Endosc. 2005;  61 528-533
  • 21 Nakai Y, Isayama H, Komatsu Y. et al . Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction.  Gastrointest Endosc. 2005;  62 742-748
  • 22 Cantu P, Hookey L C, Morales A. et al . The treatment of patients with symptomatic common bile duct stenosis secondary to chronic pancreatitis using partially covered metal stents: a pilot study.  Endoscopy. 2005;  37 735-739
  • 23 Trentino P, Falasco G, d'orta C, Coda S. Endoscopic removal of a metallic biliary stent: case report.  Gastrointest Endosc. 2004;  59 321-323
  • 24 Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic Wallstents.  Gastrointest Endosc. 2004;  60 640-644
  • 25 Familiari P, Bulajic M, Mutignani M. et al . Endoscopic removal of malfunctioning biliary self-expandable metallic stents.  Gastrointest Endosc. 2005;  62 903-910
  • 26 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
  • 27 Hammel P, Couvelard A, O'Toole D. et al . Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct.  N Engl J Med. 2001;  344 418-423
  • 28 Godil A, Chen Y K. Endoscopic management of benign pancreatic disease.  Pancreas. 2000;  20 1-13
  • 29 Katsinelos P, Paikos D, Kountouras J. et al . Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness.  Surg Endosc. 2006;  20 1587-1593
  • 30 Davids P H, Groen A K, Rauws E A. et al . Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction.  Lancet. 1992;  340 1488-1492
  • 31 Kaassis M, Boyer J, Dumas R. et al . Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study.  Gastrointest Endosc. 2003;  57 178-182
  • 32 Knyrim K, Wagner H J, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct.  Endoscopy. 1993;  25 207-212
  • 33 Wagner H J, Knyrim K, Vakil N, Klose K J. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial.  Endoscopy. 1993;  25 213-218
  • 34 Born P, Rosch T, Bruhl K. et al . Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic disease.  Hepatogastroenterology. 1998;  45 833-839
  • 35 Hausegger K A, Kugler C, Uggowitzer M. et al . Benign biliary obstruction: is treatment with the Wallstent advisable?.  Radiology. 1996;  200 437-441
  • 36 Lopez Jr. R R, Cosenza C A, Lois J. et al . Long-term results of metallic stents for benign biliary strictures.  Arch Surg. 2001;  136 664-669
  • 37 Tringali A, Di Matteo F, Iacopini F. et al . Common bile duct strictures due to chronic pancreatitis managed by self-expandable metal stents: results of a long term follow-up study.  Gastrointest Endosc. 2005;  61 abstract 220
  • 38 Isayama H, Komatsu Y, Tsujino T. et al . Polyurethane-covered metal stent for management of distal malignant biliary obstruction.  Gastrointest Endosc. 2002;  55 366-370
  • 39 Bruno M, Boermeester M, Rauws E. et al . Use of removable covered expandable metal stents (RCEMS) in the treatment of benign distal common duct (CBD) strictures: a feasibility study.  Gastrointest Endosc. 2005;  61 abstract 199

M. KahalehMD 

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