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Additional flap on plastic stents for improved antimigration effect in the treatment of post-cholecystectomy bile leak

2018; Thieme Medical Publishers (Germany); Volume: 06; Issue: 04 Linguagem: Inglês

10.1055/s-0043-125361

2364-3722

Chang‐Il Kwon, Mark A. Gromski, Hyoung‐Chul Oh, Jeffrey J. Easler, Ihab El Hajj, James L. Watkins, Evan L. Fogel, Lee McHenry, Stuart Sherman, Glen A. Lehman,

Esophageal and GI Pathology

In plastic stent insertion for treatment of post-cholecystectomy bile leak, stent migration may be more common due to the absence of a shelf to anchor the stent. We evaluated how adding a flap to straight plastic stents for this indication might influence the rate of stent migration when compared to use of conventional plastic stents.This is a retrospective study including patients referred for ERCP for treatment of post-cholecystectomy bile leak. Patients with a customized anti-migration flap stent had the additional flap created on the distal end of straight plastic stents, intended to aid in anchoring in the distal supra-sphincteric biliary duct. The primary endpoint is stent migration events. The secondary endpoint is bile leak resolution after first ERCP session.Thirty-two patients were treated with the experimental additional flap stents and 225 patients were treated with standard straight biliary stents. The total failure rate of bile leak resolution after a single endoscopic treatment for all treated was 10.5 % (27/257) and the total stent migration rate for all enrolled was 15.2 % (39/257). Stent migration rate was lower in the additional flap stent group than in the conventional group (3.1 % vs. 16.9 %, respectively, P = 0.04). Furthermore, significantly more patients had resolution of their bile leak after the first ERCP session in the group with the additional flap (100 % vs. 88 %, respectively, P = 0.03).A plastic biliary stent with an extra flap may have improved performance with regard to stent migration and resolution of bile leak over standard plastic biliary stents.