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World J Gastrointest Endosc. May 16, 2012; 4(5): 157-161
Published online May 16, 2012. doi: 10.4253/wjge.v4.i5.157
Published online May 16, 2012. doi: 10.4253/wjge.v4.i5.157
Management of an occluded biliary metallic stent
Wiriyaporn Ridtitid, Rungsun Rerknimitr, Director of Endoscopy Unit, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Ridtitid W and Rerknimitr R substantially contributed to the conception and design; Ridtitid W drafted the article; Rerknimitr R critically revised the important intellectual content; and Ridtitid W and Rerknimitr R approved the final version before publishing.
Correspondence to: Rungsun Rerknimitr, MD, Professor of Medicine, Director of Endoscopy Unit, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. ercp@live.com
Telephone: +66-2-2564356 Fax: +66-2-2527839
Received: October 13, 2011
Revised: November 15, 2011
Accepted: April 27, 2012
Published online: May 16, 2012
Revised: November 15, 2011
Accepted: April 27, 2012
Published online: May 16, 2012
Abstract
In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.