Biliary & Pancreatic Stents: Complications and Management

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Techniques in Gastrointestinal

Endoscopy

Available online 18 May 2007.

Biliary

and Pancreatic Stents: Complications and Management

Rabi

Kundu MD, FRCS and Pleskow MD

Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Biliary and pancreatic stents are important advancements in therapeutic endoscopy. Plastic stents are used

for variety of benign and malignant bile duct obstruction. Pancreatic

plastic stents currently have a role in aiding difficult biliary cannulation of the bile duct and prevention of pancreatitis after pancreatic ductal

intervention. Self-expanding metal stents (SEMS) are

used for inoperable malignant biliary obstruction. Complications

related to plastic stents are usually low, and in the event of stent occlusion

and proximal stent migration, the stent is removed by either direct, indirect

traction methods, or after stent cannulation. SEMS-related complication or malfunction is ideally

managed with removal and replacement of a SEMS. It is

easier to remove a covered SEMS. SEMS occlusion with

sludge is managed with cleaning or, in the event of tumor ingrowth

or overgrowth, placement of another SEMS. Incidence of

acute cholecystitis is varied and is usually managed

with aspiration of the gallbladder or cholecystostomy. The management of SEMS-related pancreatitis

is conservative. Rare free perforations caused by

distally migrated plastic stent are managed by surgery; however, contained peri Vaterian perforations in a

stable patient are usually managed by conservative approach.

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