Covered Self-Expanding Metal Stents for the Management of Common Bile Duct Stones

Background and Aims Little medical literature exists for the use of fully covered self-expanding metal stents (CSEMSs) in management of retained common bile duct stones. Our aim was to assess the safety and efficacy of CSEMSs for the indication of retained “difficult” common bile duct stones. Methods This retrospective cases series included 44 patients (30 female, median age 69 (range 24-88)) who underwent CSEMS insertion for the indication of retained “difficult” common bile duct stones in 2 tertiary referral centers. Patients underwent temporary placement of CSEMSs after incomplete stone clearance at endoscopic retrograde cholangiopancreatography (ERCP). Follow-up ERCP was arranged for stent removal and subsequent attempt at duct clearance. Procedure- related adverse events were also recorded. Results Successful biliary drainage was achieved in all cases after CSEMS placement. Forty-two stents were removed with successful duct clearance being achieved in 36 cases (82%) after a median in-stent duration of 8 weeks. There were 10 cases (22.7%) of stent migration, all noted incidentally during follow-up. One patient died of non-biliary causes before attempted removal. Conclusion This is the largest published retrospective case series for use of CSEMSs for management retained common bile stone disease to date. We have shown high success rates for this indication. A well-designed multicenter randomized control trial might address the uncertainty of cost/benefit ratio and appropriate duration for CSEMSs to be left in-situ. Specific stent modification for this indication, including wider distal flare and retrieval purse string loop, may also be useful.