Mechanisms and prevention of biliary stent occlusion

Shabunin A.V.; Tavobilov M.M.; Lebedev S.S.; Karpov A.A.

doi:https://doi.org/10.17116/hirurgia202005170

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Abstract:

One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of endoscopic decompression in the treatment of patients with malignant biliary obstruction as preparation before radical surgery and final palliative care. Endoscopic retrograde transpapillary stenting firmly took its place together with antegrade and percutaneous stenting. There are certain advantages of this technique including minimally invasiveness and favorable quality of life. However, this approach is associated with some drawbacks associated with stent occlusion and difficult correction of this complication. The maximum diameter of the plastic stent (PS) is determined by the width of the working channel of the duodenoscope. In this regard, self-expandable metal stents (SEMS) were developed to increase the diameter of bile drainage channel. SEMS are associated with prolonged function. However, there is another problem. It is a germination of SEMS followed by impossible removal of the stent for its subsequent replacement. A further step in development of endoscopic biliary stents was the use of special SEMS coating to exclude tumor or granulation ingrowth. The problem of biliary stent occlusion remains relevant despite some improvement of stenting results. Mechanisms of occlusion of biliary stents and prevention of these events are discussed in this review.

Keywords:

malignant biliary obstruction

plastic stent

self-expandable metal stent (SEMS)

Authors:

Shabunin A.V.

S.P. Botkin City Clinical Hospital, Moscow, Russia;
Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia

Tavobilov M.M.

Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF;
Federal'nyĭ mediko-biologicheskiĭ tsentr im. A.I. Burnaziana FMBA Rossii, Moskva

Lebedev S.S.

Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia

Karpov A.A.

A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of the Russian Federation, Obninsk, Russia

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References:

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