Biliary and pancreatic stents: Indications and placement techniques

Abstract

Placement of self-expandable metal stents (SEMS) has now become accepted for the relief of malignant obstruction of the biliary system, either preoperatively or palliatively. The advantage of SEMS over traditional plastic stents is the significant prolongation in patency. Available SEMS are uncovered, partially covered, and completely covered. Covered stents may have prolonged patency as compared to uncovered stents but, more importantly, do not imbed into tissue and thus are removable and have applications for benign disease. Applications of covered SEMS for benign biliary diseases include strictures, leaks closure of perforations, and treatment of postsphincterotomy bleeding. SEMS can be placed percutaneously or endoscopically; the latter is usually done at the time of ERCP, but endoscopic ultrasound guidance can also be used to place SEMS. Applications of SEMS in the pancreas are limited but evolving. This chapter will summarize the indications and techniques for placement of self-expandable metal stents in the biliary tree and for the treatment of pancreatic disease.