Biliary stones or ulcers at the choledochojejunal anastomotic site involving the jejunal mucosa at stent removal may be recurrent factors in patients with benign choledochojejunal anastomotic stenosis undergoing endoscopic biliary stenting using fully covered self‐expandable metal stents

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 29; no. 9; pp. 1044 - 1053
• Main Authors: Kida, Akihiko, Shirota, Yukihiro, Arihara, Fumitaka, Asai, Jun, Matsuda, Koichiro, Kakinoki, Kaheita, Matsuda, Mitsuru, Sakai, Akito, Terada, Mitsuhiro, Urabe, Takeshi
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01-09-2022
• Subjects: benign choledochojejunal anastomotic stenosis; biliary stones; endoscopic biliary stenting; Endoscopy; fully covered self‐expandable metal stent; Stents; Ulcers; ulcers at the choledochojejunal anastomotic site involving the jejunal mucosa; biliary stones; benign choledochojejunal anastomotic stenosis; endoscopic biliary stenting; ulcers at the choledochojejunal anastomotic site involving the jejunal mucosa; fully-covered self-expandable metal stent
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.1167

Background
Temporary fully covered self‐expandable metal stent (FCSEMS) placement is performed for benign choledochojejunal anastomotic stenosis (bCJS). However, recurrence may develop after stricture resolution. We investigated endoscopic biliary stenting using FCSEMS for bCJS.
Methods
Sixteen bCJS patients with FCSEMS placement were retrospectively analyzed. FCSEMS was removed endoscopically after 2 months. Technical success, stricture resolution, recurrence, and adverse events were evaluated.
Results
The technical success rate for FCSEMS placement was 94% (15/16). Biliary stones were detected and extracted in four patients. FCSEMS removal was successfully performed on 14 patients, excluding one with stent migration. At FCSEMS removal, stricture resolution was noted in 14 patients; however, four had anastomotic ulcers. The median follow‐up was 319 days. Three patients with a history of repeated plastic stent placement had no recurrence. Four out of 15 patients (27%) had recurrence, and three had no recurrence after additional interventions. Biliary stones before first FCSEMS placement (P = .003) or anastomotic ulcers at FCSEMS removal (P = .018) were associated with recurrence.
Conclusions
Although FCSEMS placement was useful for stricture resolution, recurrence was detected in patients with biliary stones before first FCSEMS placement or anastomotic ulcers at FCSEMS removal. Anastomotic ulcers are a risk factor for recurrence and only detected by endoscopy.
Kida and colleagues found that temporary fully‐covered self‐expandable metal stent placement was useful for stricture resolution of benign choledochojejunal anastomotic stenosis. However, recurrence of benign choledochojejunal anastomotic stenosis was detected in patients with biliary stones before first placement of the stent or anastomotic ulcers at the time of stent removal.