Post written by Fateh Bazerbachi, MD, from the Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.

In this case series, our team demonstrates examples of luminal applications of specialized fully covered antimigration biliary stents in different challenging scenarios. Specifically, we apply these small-caliber stents in benign radiation pan-esophageal stricture, distal malignant esophageal stricture, enteral anastomotic stricture in a patient with Crohn’s disease, and extrinsic colon compression by peritoneal carcinomatosis causing obstipation. All of these patients had limited to no alternative treatment options. We also described methods to overcome the limited small caliber (10 mm) of these stents by demonstrating a method to deploy 2 of them side-by-side in a double-barrel configuration.

Patients may present with challenging luminal strictures that may not be amenable to traditional stenting paradigms. Expanding the application of other available tools, at times off-label from their FDA indication, may help patients who have complex pathology and limited options. Our team wished to show examples where applying these specialized biliary stents with a unique constellation of properties may be advantageous, and also show how their use can be optimized in overlapping or parallel deployment.  

When encountering complex clinical scenarios, unconventional treatment approaches should be considered in an effort to better meet the needs of the patient. However, endoscopists should discuss with their patients all available options, and highlight to the best of their abilities the anticipated risks, adverse events, and conditions when applying off-label and/or unconventional therapeutic modalities, ideally with multidisciplinary input.

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