ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team

Gromski_Biliary Stents

Pdf Summary

The document is a presentation on biliary stents, focusing on choosing the right stent, planning drainage, and handling complications. It emphasizes three main decision factors: length, diameter, durability/patency, and cost.<br /><br />Plastic stents are highlighted as inexpensive and flexible, with many size combinations available. They may be preferred for cholangitis, bile leaks, and hilar strictures. The speaker notes that stent choice should consider features like migration resistance and pushability, and that biliary sphincterotomy is generally preferred before placing plastic stents 10 Fr or larger.<br /><br />Self-expanding metal stents (SEMS) are described as more durable with better patency but higher cost. Important considerations include foreshortening, deployment system, covered vs. uncovered design, and anti-migration features. SEMS are preferred for distal malignancies and difficult distal benign bile duct strictures. Covered vs. uncovered stents must be weighed for malignant distal obstruction based on removability, migration risk, cholecystitis risk, and cost.<br /><br />The presentation also covers special uses of covered SEMS, including treatment of Stapfer type II perforation, sphincterotomy-related bleeding, bleeding biliary varices, and very tight esophageal strictures.<br /><br />For hilar stenting, careful pre-procedural planning is stressed, including Bismuth classification, imaging review, diagnosis confirmation, functional status, and avoiding drainage of atrophied or poorly perfused liver lobes. Effective drainage generally requires more than 50% of liver volume, often through at least two sectors, to improve bilirubin reduction, survival, and chemotherapy eligibility.<br /><br />Finally, the talk reviews troubleshooting issues such as migrated stents, removal of uncovered metal stents, and perforation from distal migration, and briefly mentions future technologies like biodegradable and drug-impregnated stents.

Keywords

biliary stents

plastic stents

self-expanding metal stents

SEMS

biliary drainage

hilar strictures

stent migration

covered stents

uncovered stents

cholangitis