Risk of Stent Migration in Intended Long-Term Biliary Plastic Stents: Is Being Straight Good?

Excerpt

In 1980, Soehendra and Reynders-Frederix [1] first described endoscopic biliary stenting, a procedure that revolutionized the management of obstructive biliary diseases. Though endoscopic biliary sphincterotomy with stone extraction is the standard of care for common bile duct stones (CBDS) with a safety profile superior to surgery, stone extraction by balloon or basket may fail in 10–15% patients due to reasons such as stone diameter > 15 mm, > 3 stones, and unfavorable bile duct anatomy (distal CBD narrowing/angulation, large periampullary diverticulum) [2]. These difficult-to-remove CBD stones can be removed with more complex endoscopic techniques such as mechanical, laser, extracorporeal or electrohydraulic lithotripsy. Though surgical CBD exploration is usually reserved for failure or unavailability of all of these interventions, significant comorbidities in elderly patients may preclude multiple endoscopic interventions or surgery. In this subset of patients, long-term biliary stenting [3, 4] may be used with either repeated planned exchanges or as a one-off procedure with exchanges reserved solely for obstruction, cholangitis or migration. …