Status evaluation reportPancreatic and biliary stents
Section snippets
Background
Biliary and pancreatic stents are tubular devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct. Stents may also be used to treat biliary/pancreatic leaks or to prevent post-ERCP pancreatitis. This report is an update of the technical considerations of available stents including indications for their use, efficacy, safety, and financial considerations.
Biliary
Plastic biliary stents are composed of polyethylene, polyurethane, or Teflon1 (Table 1). Stent diameter and length vary from 5F to 12F and 1 to 18 cm, respectively (Table 1). Stents that are 10F require an endoscope with a 3.7-mm accessory channel; larger stents (11.5F and larger) require a 4.2-mm channel. Plastic biliary stents are available in a variety of configurations. Pigtail stents are coiled at 1 or both ends (single or double pigtail). Side holes are placed along the curved pigtail
Self-expandable metal stents
Self-expanding metal stents (SEMSs) were developed to increase stent diameter, thereby increasing the patency duration and reducing recurrent obstruction.2 SEMSs are constructed of a variety of metal alloys (eg, nitinol [Elgiloy, Specialty Metals, Elgin, Ill). These materials are used to achieve adequate radial expansile force without sacrificing flexibility and conformability to the duct.3 SEMSs range from 4 to 12 cm in length with diameters when expanded ranging from 6 to 10 mm (Table 3).
Most
Areas for future research
Further investigation into how to increase the duration of patency of both plastic and metal stents is needed. In vivo studies of how to decrease bacterial adhesion and bacterial biofilm formation in plastic stents should be performed. Larger, randomized studies are needed comparing the safety, clinical effectiveness, and cost-effectiveness of the use of covered SEMSs versus plastic stents in the treatment of benign strictures. Small studies have shown that endoscopically-placed, drug-eluting
Summary
Biliary and pancreatic stents are used in a variety of benign and malignant conditions including strictures and leaks and in the prevention of post-ERCP pancreatitis. Both plastic and metal stents are safe, effective, and easy to use. SEMSs have traditionally been used for inoperable malignant disease. Covered SEMSs are now being evaluated for use in benign disease. Increasing the duration of patency of both plastic and metal stents remains an important area for future research.
Disclosure
All authors disclosed no financial relationships relevant to this publication.
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This document is a product of the Technology Assessment Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.