Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting: a prospective study with 2 years of follow-up

Parenchymal fibrosis in chronic pancreatitis (CP) may induce stricturing of the common bile duct. The prevalence of CP-related benign biliary stricture (BBS) ranges between 3% and 46%.1 A durable drainage is needed if the stricture results in persistent increase in liver function test (LFT) results, jaundice, and cholangitis.2 If left untreated, symptomatic BBS can lead to secondary biliary cirrhosis.3 Biliodigestive anastomosis (hepaticojejunostomy) is the treatment of choice for persistent CP-related BBS.1,4 However, surgery may be difficult because of local complications of CP, mainly portal hypertension, and limited by other comorbidities or patient refusal. Endoscopic biliary stenting may be an alternative to surgery, being minimally invasive and having a lower short-term complication rate and a shorter hospital stay.5-8 Furthermore, endoscopic biliary drainage does not preclude subsequent surgery when necessary.9 Endoscopic treatment of BBS includes the placement of plastic stents or self-expandable metal stents (SEMSs). Long-term results of the placement of plastic stents are disappointing.10-13 Biliary SEMSs are uncovered or partially covered (PC) with a plastic coating. More recently, fully covered (FC) SEMSs have been developed and, being removable, are proposed also for benign indications. Uncovered and PC biliary SEMSs may clog because of tissue ingrowth through the uncovered meshes.14,15 Removable FC SEMSs are an attractive option for CP-related BBS, but limited data are available. We conducted a prospective, single-center trial to investigate the durability of CP-related BBS resolution after temporary insertion of FCSEMSs with unflared ends (UEs) and flared ends (FEs).