Biliary and Pancreatic Stents: Complications and Management

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. (C) 2007 Elsevier Inc. All rights reserved.