Fully covered metal biliary stents: A review of the literature

Table 1 Strengths and disadvantages of plastic stents and self-expandable metal stents

	Strengths	Disadvantages
Plastic stents	Easy placement, removal, and exchange; Cost-effective for use < 4 mo; Variety of shapes and sizes	Tendency for stent occlusion after several months
Uncovered self-expandable metal stents (USEMS)	Long stent patency due to large luminal diameter; Stent malposition is rare	Cost-effective for use > 4 mo; High risk for tissue ingrowth or tumor overgrowth; Risk for duodenal wall erosion; Biliary leakage possible; Difficult to reposition or remove
Partially covered self-expandable metal stents (PCSEMS)	Long stent patency due to large luminal diameter; Biliary leakage is rare	Cost-effective for use > 4 mo; Intermediate risk for tissue ingrowth or tumor overgrowth; Risk for duodenal wall erosion; Difficult to reposition or remove; Side branch obstruction possible
Fully covered self-expandable metal stents (FCSEMS)	Long stent patency due to large luminal diameter, covering inhibits tissue/tumor in-growth through mesh; No biliary leakage	Cost-effective for use > 4 mo; Risk for duodenal wall erosion; Difficult to reposition or remove; High risk of stent migration; Side branch obstruction possible

Table 2 Etiology of benign biliary strictures

Extrinsic	Intrinsic
Chronic pancreatitis	Post-operative (i.e., post-liver transplantation and post-cholecystectomy)
Pancreatic fluid collection	Primary sclerosing cholangitis
Cholecystitis	IgG Cholangiopathy

IgG: Immunoglobin G.

Table 3 Comparison of study outcomes of plastic stents and fully covered self-expandable metal stents for treatment of post-operative benign biliary strictures

Ref.	Methods	Patients	Stent placement	Followup time(mo)	Clinical success1 (%)	Recurrence (%)
Bergman et al[42]	Retrospective, single center	57	Two 10F plastic stents	24	77	20
Costamagna et al[41]	Retrospective, single center	154	Multiple plastic stents	108	96.7	12
Chaput et al[44]	Retrospective, single center	92	FCSEMS	12	84.9	21.9
Tringali et al[47]	Prospective, mult-center	187	FCSEMS	60	83.3	15.4

¹Clinical success defined as removal of stent for resolution of benign biliary stricture. FCSEMS: Fully covered self-expandable metal stents.

Table 4 Comparison of study outcomes usng fully covered self-expanding metal stents for treatment of biliary leak

Ref.	Methods	Patients	Type, duration of stent placement (mo)	Follow-up time (mo)	Clinical success rate1 (%)
Martins et al[110]	Restrospective, single center	31	PCSEMS (3), FCSEMS with fins (3.3), FCSEMS with flare ends (3)	PCSEMS (44), FCSEMS with fins (27), FCSEMS with flare ends (6.6)	PCSEMS (100), FCSEMS with fins (77.8), FCSEMS with flare ends (70)
Lalezari et al[111]	Retrospective, single center	5	FCSEMS with fins (3)	26	100
Kahaleh et al[112]	Retrospective single, center	16	FCSEMS (3)	9	94

¹Clinical success rate defined as resolution of biliary leak confirmed with imaging. PCSEMS: Partially covered self-expandable metal stents; FCSEMS: Fully covered self-expandable metal stents.