Editor’s Choice- Stuart Sherman

Associate Editor, Stuart Sherman, MD, FASGE, recommends the article “Fully covered self-expandable metal stents for the treatment of benign biliary strictures” by Arthur J. Kaffes, MBBS, FRACP and Ken Liu,  MBBS, BSci (Med) from the July issue of GIE.

This review article highlights the use of fully covered self-expandable metal stents (FCSEMSs) as a potential paradigm shift in our management of benign biliary strictures.

This review is well-written and is encyclopedic in summarizing the world’s literature on the performance, clinical utility, and safety  of FCSEMSs for the treatment of benign biliary strictures. As an evolving area of investigation, this is a very timely review.

Figure 3

Figure 3. These fluoroscopic images illustrate one of the newer intraductal fully covered self-expandable metal stent type used in a 53-year-old woman with an anastomotic stricture after orthotopic liver transplantation (OLT). A, Cholangiogram clearly demonstrating a tight anastomotic stricture post-OLT. B, The FCSEMS (Niti-S Kaffes; Taewoong) is inserted across the stricture and is entirely within the biliary tree. C, The stent is seen in situ with the radiopaque removal string seen clearly in the duodenum (white arrow). D, The stricture has completely resolved.

There are limited data on the use of FCSEMS and only 1 small RCT published as an abstract. Based on these limited data, it would appear that:

  1. Placement of FCSEMSs in the treatment of benign biliary strictures is feasible and effective in both the post-transplant and non-transplant settings as a first or second line therapy.
  2. Similar success rates occur with the plastic stents; however, since FCSEMSs require fewer endoscopic sessions to achieve clinical success, they will likely be cost effective.
  3. It appears that the complication rates of plastic stents and FCSEMSs are similar.
  4. FCSEMSs are currently not approved by the FDA for the indication of benign biliary strictures in the USA.
  5. Further prospective randomized trials are needed to assess efficacy of FCSEMSs compared with plastic stents and their long-term safety and cost-effectiveness before routine use can be recommended for benign biliary strictures.

Read this article on pages 13-21 in the print journal or find it online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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