Entfernen eines unbeschichteten Metallstents aus den Gallenwegen 6 Jahre nach Implantation bei chronisch kalzifizierender Pankreatitis

Zusammenfassung

Standard in der Therapie benigner Stenosen der Gallenwege sind beschichtete Metallstents oder das Multistenting mit Plastikstents. Unbeschichtete Metallstents werden nicht empfohlen, da sie bei längerer Liegezeit einwachsen und es bisher als unmöglich galt, sie mit vertretbarem Risiko zu entfernen.

Wir berichten von einer Patientin mit chronisch kalzifizierender Pankreatitis und Cholestase, die nach frustranem Multistenting mit insgesamt 15 Stentwechseln einen unbeschichteten Metallstent als Zweitlinientherapie in den Ductus hepatocholedochus implantiert bekam. Nachdem dieser Stent sechs Jahre lang gelegen hatte und in dieser Zeit insgesamt 19-mal per Ballondurchzug gereinigt werden musste, stellte sich die Indikation zur Entfernung.

Ins Lumen des unbeschichteten Stents wurde ein 2 cm längerer, beschichteter Metallstent von gleichem Kaliber eingelegt. Dieser wurde 9 Monate vor Ort belassen und in dieser Zeit einmal gereinigt. Abschließend wurden beide Stents per ERCP zunächst teleskopartig auseinandergezogen, dann vorsichtig mit der Zange mobilisiert und schließlich komplett aus dem Gallengang entfernt. Die Patientin blieb im weiteren Verlauf beschwerdefrei und ohne Cholestase.

Die Stent-in-Stent-Technik zum Entfernen unbeschichteter Stents wurde erstmals für den Ösophagus beschrieben. Unser Fall zeigt, dass sie auch in den Gallenwegen und auch nach längerer Liegezeit anwendbar ist.

Abstract

Standard therapy for benign stenoses of the biliary tract are coated metal stents or multi-stenting with plastic stents. Uncoated metal stents are not recommended because tissue ingrowth and overgrowth may render them impossible to remove with acceptable risk.

We report a patient with chronic calcifying pancreatitis and cholestasis who, after unsuccessful multistenting with a total of 15 stent changes, was implanted with an uncoated metal stent in the common bile duct as second-line therapy. After this stent had been in place for six years and had to be balloon-cleaned 19 times during this time, the indication for removal came up. 

A fully coated metal stent of the same diameter but 2 cm longer was inserted into the lumen of the uncoated stent. It was left in place for 9 months and cleaned once during this time. Then, via ERCP, both stents were extended in a telescope-like manner, mobilized using a forceps and finally removed from the bile duct. Afterwards, the patient remained symptomless and free from cholestasis.

The stent-in-stent technique for removing uncoated stents was first described for the esophagus. Our case shows that it can also be used in the biliary tract and even after an extended period of time.

Schlüsselwörter

Metallstent unbeschichtet - Stent-Entfernung - benigne Gallengangstenose - chronische Pankreatitis - DHC - Stent-in-Stent-Technik

Key Words

metal stent uncovered - stent removal - benign bile duct stenosis - chronic pancreatitis - CBD - stent-in-stent technique

Publication History

Received: 26 February 2020

Accepted: 09 April 2020

Article published online:
07 May 2020

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