Post written by Aamir Saeed, MD, from the Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
In this meta-analysis, we aimed to assess the efficacy and safety of fully covered self-expandable metal stents (FCSEMSs) in the management of postsphincterotomy bleeding.
Endoscopic sphincterotomy is commonly performed during ERCP to assist in various therapeutic interventions such as stone removal and stent placement. However, endoscopic sphincterotomy is associated with risks of adverse events such as bleeding and perforation even when performed by an experienced endoscopist. Conventional endoscopic treatments for postsphincterotomy bleeding include balloon tamponade, epinephrine injection, bipolar cautery, hemostatic clips, and angiographic embolization. FCSEMSs are often used in the management of postsphincterotomy bleeding that is refractory to conventional endoscopic treatments.
A recently published retrospective study1 showed 100% immediate hemostasis with FCSEMSs. Data to evaluate the safety and efficacy of FCSEMSs in the management of postsphincterotomy bleeding were limited.
Seven studies with a total of 224 patients met our inclusion criteria. Our results showed that pooled rates were 95% (95% CI, 89-98; I2 = 12%) for clinical success, 7% (95% CI, 4-12; I2 = 0%) for recurrent bleeding, 6% (95% CI, 2-16; I2 = 58%) for adverse events, 7% (95% CI, 2-19; I2 = 62%) for pancreatitis, and 10% (95% CI, 5-20 ; I2 = 50%) for stent migration. Subgroup analysis that included studies where FCSEMSs were used as rescue treatment found that the pooled rates of clinical success were 97% (95% CI, 91-99; I2 = 0%).
This systematic review and meta-analysis demonstrates the pooled efficacy and safety of FCSEMS use in the management of postsphincterotomy bleeding, especially as rescue treatment in patients with persistent bleeding after conventional endoscopic treatments. More studies are needed to compare FCSEMSs as a monotherapy versus conventional endoscopic management of postsphincterotomy bleeding to examine whether FCSEMSs can be used as monotherapy.
Rate of clinical success of fully covered self-expandable metal stents. CI, Confidence interval.
Read the full article online.
- Bilal M, Chandnani M, McDonald NM, et al. Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding. Endosc Int Open 2021;9:E667-73. ↩︎
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.
endoscopedia.com 