Stenting with standard biliary fully covered self-expandable metal stents (FCSEMSs)
has been reported as successful treatment for complications after biliary sphincterotomy
such as bleeding, perforation, or stenosis [1]. However, in some situations, such as a dilated common bile duct (CBD) or large
sphincterotomy, these stents are not watertight, which can lead to persistent bleeding
and leakage, or a malfunction [1]
[2]. A new, shaped, large covered stent could be an interesting solution, with maximal
radial and axial force achieving adequate local compression to allow calibration of
a stenosis, hemostasis, or a watertight seal to be created [3]
[4]. Here, we report our early experience with the use of these new stents in the CBD
in two patients ([Video 1]).
Video 1 Endoscopic retrograde cholangiopancreatographies performed in two patients during
which temporary fully covered lumen-apposing metal stents (FCLAMSs) are delivered:
a to treat massive bleeding following a maximally sized sphincterotomy for residual
stones; b to treat complete stenosis of a bilioduodenal anastomosis following surgical
ampullectomy.
The first patient was an 89-year-old woman who underwent a maximal re-cut after a
previous sphincterotomy for residual stones in a dilated CBD. She re-presented 12
hours later with hypovolemic shock and melena. After resuscitation, she underwent
an emergency endoscopic retrograde cholangiopancreatography (ERCP), which showed active
arterial bleeding from the roof of the sphincterotomy. Injection of adrenaline, insertion
of a standard 10-mm diameter FCSEMS, and forced coagulation of the visible vessel
using a CoGasper did not achieve hemostasis. Because of the size of the sphincterotomy
and the dilatation of the CBD, we decided to place a fully covered lumen-apposing
metal stent (FCLAMS). A 4-cm × 14-mm FCLAMS was successfully delivered with complete
hemostasis being achieved. Bleeding did not recur and the stent was removed 5 days
later without complications.
The second patient was a 67-year-old man who had undergone surgical resection of the
pancreatic papilla for high grade dysplasia 3 months previously. He presented with
acute cholangitis due to complete anastomotic stenosis of the CBD with marked dilatation.
A 3-cm × 14-mm FCLAMS was successfully delivered. The patient was discharged on day
1 and has been scheduled for removal of the stent.
The present cases suggest that placement of a transpapillary FCLAMS could be an interesting
alternative for treating post-sphincterotomy bleeding and to calibrate stenosis, in
patients with a dilated CBD and/or a large sphincterotomy orifice.
Endoscopy_UCTN_Code_TTT_1AR_2AK
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
