FULLY-COVERED SELF-EXPANDABLE METAL STENTS (FCSEMS) AS RESCUE TREATMENT FOR POST-SPHINCTEROTOMY BLEEDING AND BILE DUCT PERFORATION. A CASE SERIES FROM A GREEK REFERRAL CENTRE

Aims FCSEMS have been used as a «rescue treatment» for several urgent biliary tract conditions. This study evaluated the efficacy, safety, and duration of stenting with FCSEMS in extremely high-risk conditions: post-sphincterotomy bleeding and bile duct perforations.

Methods This is a retrospective study including patients who were treated with FCSEMS placement for post or during ERCP complications: uncontrolled post-sphincterotomy bleeding where hemostasis methods were unsuccessful and perforation after balloon dilation or sphincterotomy. The study was conducted in a Greek referral centre from January 2017 to March 2021 and reported stenting duration, safety of FCSEMS removal, clinical efficacy, complications, and long-term outcome.

Results A total of 1706 ERCP procedures were done during the study period. 14 (0,8%) patients (9 male; mean age 60±4 years) underwent FCSEMS placement, 5 patients due to post-sphincterotomy bleeding and 9 due to perforation (8 after balloon dilation and 2 after sphincterotomy). Median duration of stenting was 19 (14–21) days for the patients with bleeding and 40 (38–60) days for those with perforation. Complete resolution of the complication was achieved in all patients. There were no complications regarding the FCSEMS installation and removal. No recurrence of bleeding or delayed perforation was observed during follow-up (4–12 weeks).

Conclusions In our study, temporary placement of FCSEMS was a very effective rescue treatment for difficult-to-control post-sphincterotomy bleeding and perforation. Duration of stenting was different for each type of condition. The short-term stenting was associated with the absence of early or late complications.

Publication History

Article published online:
14 April 2022