Endoskopie heute 2012; 25(1): 18-23
DOI: 10.1055/s-0031-1283925
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Temporäre Metall Stents zur Therapie benigner Gallengangsläsionen

Temporary Metal Stents for Treatment of Benign Biliary Lesions
P. Sauer
1   Interdisziplinäres Endoskopie-Zentrum, Universitätsklinik Heidelberg
,
F. Chahoud
1   Interdisziplinäres Endoskopie-Zentrum, Universitätsklinik Heidelberg
,
D. Gotthardt
1   Interdisziplinäres Endoskopie-Zentrum, Universitätsklinik Heidelberg
,
M. Burian
1   Interdisziplinäres Endoskopie-Zentrum, Universitätsklinik Heidelberg
,
A. Schaible
1   Interdisziplinäres Endoskopie-Zentrum, Universitätsklinik Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
15 March 2012 (online)

Zusammenfassung

Wir untersuchten die Sicherheit, den klinischen Erfolg und die Komplikationsrate von komplett beschichteten Metallstents (fcSEMS) bei 36 Patienten mit benignen biliären Stenosen und Leckagen und erfolgloser konventioneller endoskopischer Therapie. Die Indikation zur Implantation war eine biliäre Läsion nach Lebertransplantation (n = 23), Leberresektion (n = 6), Cholezystektomie (n = 2), chronischen Pankreatitis (n = 2), iatrogener Perforation nach ERC (n = 3).

Die Platzierung und Entfernung der fcSEMS gelang ohne Komplikationen. Bei 30 Patienten konnte die Therapie (Therapiedauer im Mittel 13 Wo.) abgeschlossen werden. Die Erfolgsrate bezogen auf alle Patienten lag bei 69 %, bezogen auf die Patienten, die die Therapie abschließen konnten bei 83 %. Bei den Patienten ohne therapeutischen Erfolg war eine chirurgische Revision bzw. Retransplantation erforderlich. Insgesamt wurden bei 14 Patienten Komplikationen beobachtet. Dies entspricht einer Komplikationsrate von 39 %. Die interventionspflichtige Komplikationsrate lag bei 14 %.

Komplett beschichtete, temporär eingesetzte Metallstents sind in der endoskopischen Therapie benigner Gallengangsstenosen und -leckagen eine Erweiterung des therapeutischen Spektrums mit akzeptabler Komplikationsrate. Falls die konventionelle endoskopische Therapie keinen Erfolg bringt, könnten sich diese Stents zumindest bei biliären Komplikationen nach Lebertransplantation und akuten Gallengangsverletzungen als eine Alternative zur chirurgischen Intervention etablieren. Eine Evaluierung als primäre endoskopische Therapie bei definierten Indikationen erscheint in prospektiven Studien gerechtfertigt.

Abstract

In the present study we evaluated safety, efficacy and complications of temporary fully-covered, self-expandable metal stents (fcSEMS) in 36 patients with benign biliary strictures and leakage that failed after standard endoscopic procedures. Indication for fcSEMS was biliary lesions after liver transplantation (n = 23), partial liver resection (n = 6), cholezystectomy (n = 2), chronic pancreatitis (n = 2) and common duct injury after ERC (n = 3).

Placement of fcSEMS and removal in scheduled patients was successful and without complications. Treatment was completed in 30 patients after a mean of 13 weeks. Success rate concerning all patients was 69 %, concerning only patients with completed treatment it was 83 %. In patients without therapeutic success surgical reintervention or retransplantation was required. An overall complication rate of 39 % (14 patients) was noted, but an intervention was required in only 5 patients resulting in a complication rate of 14 %.

Temporary placement of fcSEMS in benign biliary strictures and leaks offers an extension of therapeutic options with satisfactory results and acceptable complication rate. At least in patients with biliary lesions after liver transplantation or acute biliary injury and failure of standard endoscopic treatment fcSEMS may become an alternative approach to surgical intervention. Prospective trials evaluating temporary placement of fcSEMS as first line approach seems justified.

 
  • Literatur

  • 1 van Boeckel PG, Vieggaar FP, Siersema PD. Plastic or metal stents for benign extrahepatic biliary strictures: a systemstic review. BMC Gastroenterol 2009; 9: 96
  • 2 Behm B, Brock A, Clarke BW et al. Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis. Endoscopy 2009; 41: 547-551
  • 3 Chaput U, Scatton O, Bichard P et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc 2010; 72: 1167-1174
  • 4 Kahaleh M, Behm B, Clarke BW et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm?. Gastrointest Endosc 2008; 67: 446-454
  • 5 Wang AY, Ellen K, Berg CL et al. Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data – a case series. Endoscopy 2009; 41: 781-786
  • 6 Cahen DL, Rauws EAJ, Gouma DJ et al. Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: A case series. Endoscopy 2008; 40: 697-700
  • 7 Mahajan A, Ho H, Sauer B et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation. Gastrintest Endosc 2009; 70: 303-309
  • 8 Traina M, Tarantino I, Barresi L et al. Efficacy and safety of fully covered self-expandable metaillic stents in biliary complications after livertransplantation: a preliminary study. Liver Transplant 2009; 15: 1493-1498
  • 9 Garcia-Pajares F, Sanchez-Antolin G, Pelayo SL et al. Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. Transplant Proceed 2010; 42: 2966-2969
  • 10 Tee HP, James MW, Kaffes AJ. Placement of removable metal biliary stent in postorthotopic liver transplantation anastomotic stricture. World j Gastroenterol 2010; 16: 3597-3600
  • 11 Phillips MS, Bonatti H, Sauer BG et al. Elevated stricture rate following the use of fully covered self-expandable metal biliary stents for biliary leaks following liver transplantation. Endoscopy 2011; 43: 512-517
  • 12 Kasher JA, Corasanti JG, Tarnasky PR et al. A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP. Gastrointest Endosc 2011; 73: 1292-1297
  • 13 Sauer P, Chahoud F, Gotthardt D et al. Temporary placement of fully covered self-expandable metal stents in biliary complications after liver transplantation. Endoscopy 2012; [in press]
  • 14 Costamagna G, Pandolfi M, Mutignani M et al. Long-term results of endoscopic management of postoperative bile duct strictures with increasing number of stents. Gastrointest Endosc 2001; 54: 162-168
  • 15 Pitt HA, Kaufman SL, Coleman J et al. Benign postoperative biliary strictures: operate or dilate?. Ann Surg 1989; 210: 417-427
  • 16 Berkelhammer C, Kortan P, Haber GB. Endoscopic biliary prostheses as treatment for benign postoperative bile duct strictures. Gastrointest Endosc 1989; 35: 95-101
  • 17 Huibregtse K, Katon RM, Tytgat GN. Endoscopic treatment of postoperative biliary strictures. Endoscopy 1986; 18: 133-137
  • 18 Sandha GS, Bourke MJ, Haber GB et al. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc 2004; 60: 567-574
  • 19 Pfau PR, Kochman ML, Lewis JD et al. Endoscopic management of postoperative complications in orthotopic liver transplantation. Gastrointest Endosc 2000; 52: 55-63
  • 20 Barthet M, Bernard JP, Duval JL et al. Biliary stenting in benign biliary stenosis complicating chronic calcifying pancreatitis. Endoscopy 1994; 26: 569-572
  • 21 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
  • 22 Kulaksiz H, Weiss KH, Gotthardt D et al. Is stenting necessary after balloon dilation of post-transplantation biliary strictures? Results of a prospective comparative study. Endoscopy 2008; 40: 746-751
  • 23 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
  • 24 van Berkel AM, Cahen DL, van Westerloo DJ et al. Self-expanding metal stents in benign biliary strictures due to chronic pancreatitis. Endoscopy 2004; 36: 381-384
  • 25 Lopez RR, Cosenza CA, Lois J et al. Long-term results of metallic stents for benign biliary strictures. Arch Surg 2001; 36: 664-669
  • 26 Yamaguchi T, Ishihara T, Seza K et al. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis. World J Gastroenterol 2006; 12: 426-430
  • 27 Verdonk RC, Buis CI, Porte RJ et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006; 12: 726-735