Management of complications associated with partially covered biliary metal stents.

BACKGROUND: Partially covered metal stents (PCMS) have been increasingly used for both malignant and benign biliary indications. This study reports their complications and subsequent management.

METHODS: Over 5 years, all patients receiving biliary PCMS were followed prospectively until stent-related dysfunction or death. Data were analyzed for the following variables: primary disease, time until revision, and type and reason for revision.

RESULTS: PCMS were placed in 396 patients (247 with malignant biliary strictures and 149 with benign biliary disease). Complications were observed in 70 patients (18%), occurring a mean time following placement of 159 days. Duodenal migration occurred in 27 cases (6.8%), while proximal migration occurred in 9 cases (2.3%). Cholecystitis was documented in 13 cases (3.3%). There were six cases of stent occlusion due to debris or sludge (1.6%), four cases of pancreatitis (1%), four cases of tumor overgrowth (1%), three cases of benign stenosis in the uncovered portion of the PCMS (0.8%), two cases of abdominal pain (0.5%), one case of an infected biloma (0.3%), and one case of a liver abscess (0.3%).

CONCLUSIONS: Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications.