USEFULNESS OF FULLY COVERED SELF-EXPANDABLE METAL STENTS AS TREATMENT OF POST-ERCP BLEEDING

Aims:

In patients undergoing ERCP, post-procedure bleeding is a frequent complication with a high morbidity and mortality. The placement of a fully covered self-expandable metal stent (FCSMES) has been documented as a useful procedure for treatment of refractory bleeding. Our objective is to evaluate our experience in using FCSMS for treatment of inmmediate and delayed post-ERCP bleeding.

Methods:

Retrospective case series study of all post-ERCP bleeding (immediate and delayed) treated with FCSEMS in a Spanish tertiary care referral hospital between January 2015 and June 2017 were included. Two situations were considered: 1) Treatment of refractory bleeding with FCSEMS; 2) Prophylactic stent placement after self-limitation or effective endoscopic treatment of the bleeding.

Results:

1,152 ERCPs were performed with 22 cases (14 male, 8 women) of clinically significant bleeding treated with FCSEMS. Coledocolithiasis was the indication for all ERCPs. 10/22, 3/22, 1/22 of patients presented with cardiologic comorbidity, cirrhosis and chronic kidney disease, respectively. 6/22 patients took platelet antiaggregants and 8/22 were anticoagulated. Difficult biliary cannulation occurred in 9 cases, conventional sphincterotomy was used in all but one patient, precut in 4 patients and sphincteroplasty in 3 patients. Most cases were mild bleedings but 6/22 and 2/22 patients presented moderate and severe bleeding respectively according to Cotton's grading system. In 15/22 the stent was used as treatment of acute bleeding (in 7 cases a second ERCP was performed to place the prosthesis) whereas in 7/22 the stent was placed prophylactically. Success (defined as absence of rebleeding) was achieved in all but one patient who then needed angiographic embolization. There were no direct complications, though stent migration occurred in 2 patients and 2 patients died for reasons not related to post-ERCP bleeding.

Conclusions:

FCSEMS can be an effective endoscopic treatment for post-ERCP bleeding with a high success rate and a low risk of complications.