Biliary stenting: Indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.

The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage.

• References

• 1 Dumonceau JM, Heresbach D, Deviere J et al. Biliary stents: models and methods for endoscopic stenting. European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2011; 43: 617-626
• 2 Dumonceau JM, Riphaus A, Aparicio JR et al. European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy 2010; 42: 960-974
• 3 Dumonceau J-M, Polkowski M, Larghi A et al. Indications, results and clinical impact of EUS-guided sampling in Gastroenterology: ESGE Clinical Guideline. Endoscopy 2011; 43: 1-16
• 4 Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ 2001; 323: 334-336
• 5 Artifon ELA, Sakai P, Ishioka S et al. Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate: a prospective randomized control trial. J Clin Gastroenterol 2008; 42: 815-819
• 6 Giorgio PD, Luca LD. Comparison of treatment outcomes between biliary plastic stent placements with and without endoscopic sphincterotomy for inoperable malignant common bile duct obstruction. World J Gastroenterol 2004; 10: 1212-1214
• 7 Hui C-K, Lai K-C, Yuen M-F et al. Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis?. Gastrointest Endosc 2003; 58: 500-504
• 8 Mavrogiannis C, Liatsos C, Papanikolaou IS et al. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study. Eur J Gastroenterol Hepatol 2006; 18: 405-409
• 9 Banerjee N, Hilden K, Baron TH et al. Endoscopic biliary sphincterotomy is not required for transpapillary SEMS placement for biliary obstruction. Dig Dis Sci 2011; 56: 591-595
• 10 Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Reviews 2006; (02) CD004200. Updated March 2009
• 11 Rey JF, Beilenhoff U, Neumann CS et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy 2010; 42: 764-772
• 12 Tringali A, Mutignani M, Milano A et al. No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy 2008; 40: 93-97
• 13 Williams EJ, Taylor S, Fairclough P et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. . Gut 2007; 56: 821-829
• 14 Varadarajulu S, Kilgore ML, Wilcox CM et al. Relationship among hospital ERCP volume, length of stay, and technical outcomes. Gastrointest Endosc 2006; 64: 338-347
• 15 Raymondos K, Panning B, Bachem I et al. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy 2002; 34: 721-726
• 16 Etzkorn KP, Diab F, Brown RD et al. Endoscopic retrograde cholangiopancreatography under general anesthesia: indications and results. Gastrointest Endosc 1998; 47: 363-367
• 17 Ramirez FC, Dennert B, Sanowski RA. Success of repeat ERCP by the same endoscopist. Gastrointest Endosc 1999; 49: 58-61
• 18 Choudari CP, Sherman S, Fogel EL et al. Success of ERCP at a referral center after a previously unsuccessful attempt. Gastrointest Endosc 2000; 52: 478-483
• 19 Maranki J, Hernandez AJ, Arslan B et al. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy 2009; 41: 532-538
• 20 England RE, Martin DF, Morris J et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. Gut 2000; 46: 395-400
• 21 van Berkel A-M, Huibregtse IL, Bergman JJGHM et al. A prospective randomized trial of Tannenbaum-type Teflon-coated stents versus polyethylene stents for distal malignant biliary obstruction. Eur J Gastroenterol Hepatol 2004; 16: 213-217
• 22 van Berkel AM, Boland C, Redekop WK et al. A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. Endoscopy 1998; 30: 681-686
• 23 Isayama H, Komatsu Y, Tsujino T et al. A prospective randomised study of “covered” versus “uncovered” Diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53: 729-734
• 24 Katsinelos P, Kountouras J, Paroutoglou G et al. Uncovered Hanaro versus Luminex metal stents for palliation of malignant biliary strictures. J Clin Gastroenterol 2008; 42: 539-545
• 25 Loew BJ, Howell DA, Sanders MK et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc 2009; 70: 445-453
• 26 Shah RJ, Howell DA, Desilets DJ et al. Multicenter randomized trial of the spiral Z-stent compared with the Wallstent for malignant biliary obstruction. Gastrointest Endosc 2003; 57: 830-836
• 27 Ballinger AB, McHugh M, Catnach SM et al. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut 1994; 35: 467-470
• 28 Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 2002; 56: 835-841
• 29 Luman W, Cull A, Palmer KR. Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol 1997; 9: 481-484
• 30 Weston BR, Ross WA, Wolff RA et al. Rate of bilirubin regression after stenting in malignant biliary obstruction for the initiation of chemotherapy: how soon should we repeat endoscopic retrograde cholangiopancreatography?. Cancer 2008; 112: 2417-2423
• 31 Moss AC, Morris E, Leyden J et al. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev 2007; 33: 213-221
• 32 Artifon ELA, Sakai P, Cunha JEM et al. Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 2006; 101: 2031-2037
• 33 Moss AC, Morris E, Leyden J et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 2007; 19: 1119-1124
• 34 Schmassmann A, von Gunten E, Knuchel J et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 1996; 91: 654-659
• 35 Yeoh KG, Zimmerman MJ, Cunningham JT et al. Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 1999; 49: 466-471
• 36 Yoon W, Ryu J, Yang K et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 2009; 70: 284-289
• 37 Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc 1988; 34: 412-417
• 38 Sherman S, Lehman G, Earle E et al. Multicenter randomized trial of 10 French versus 11.5 French plastic stents for malignant bile duct obstruction. Gastrointest Endosc 1996; 43: 396
• 39 Kadakia SC, Starnes E. Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. Gastrointest Endosc 1992; 38: 454-459
• 40 Pereira-Lima JC, Jakobs R, Maier M et al. Endoscopic biliary stenting for the palliation of pancreatic cancer: results, survival predictive factors, and comparison of 10-French with 11.5-French gauge stents. Am J Gastroenterol 1996; 91: 2179-2184
• 41 Seitz U, Vadeyar H, Soehendra N. Prolonged patency with a new-design Teflon biliary prosthesis. Endoscopy 1994; 26: 478-482
• 42 Terruzzi V, Comin U, De Grazia F et al. Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis. Gastrointest Endosc 2000; 51: 23-27
• 43 Tringali A, Mutignani M, Perri V et al. A prospective, randomized multicenter trial comparing DoubleLayer and polyethylene stents for malignant distal common bile duct strictures. Endoscopy 2003; 35: 992-997
• 44 Dua K, Reddy N, Rao V et al. Impact of reducing duodenobiliary reflux on biliary stent patency: an in vitro evaluation and a prospective randomized clinical trial that used a biliary stent with an antireflux valve. Gastrointest Endosc 2007; 65: 819-828
• 45 Lawrence C, Romagnuolo J, Payne KM et al. Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals. Gastrointest Endosc 2010; 72: 558-563
• 46 Galandi D, Schwarzer G, Bassler D et al. Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. Cochrane Database Syst Rev 2002; (03) CD003043
• 47 Matsuda Y, Shimakura K, Akamatsu T. Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol 1991; 86: 843-849
• 48 Kullman E, Frozanpor F, Söderlund C et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 2010; 72: 915-923
• 49 Telford JJ, Carr-Locke DL, Baron TH et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 2010; 72: 907-914
• 50 Lai EC, Mok FP, Fan ST et al. Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg 1994; 81: 1195-1198
• 51 van der Gaag NA, Rauws EAJ, van Eijck CHJ et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362: 129-137
• 52 Wang Q, Gurusamy KS, Lin H et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2008; (03) CD005444
• 53 Motte S, Deviere J, Dumonceau JM et al. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology 1991; 101: 1374-1381
• 54 Chen VK, Arguedas MR, Baron TH. Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte-Carlo decision analysis. Clin Gastroenterol Hepatol 2005; 3: 1229-1237
• 55 Kahaleh M, Brock A, Conaway MR et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis. Endoscopy 2007; 39: 319-324
• 56 Mullen JT, Lee JH, Gomez HF et al. Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg 2005; 9: 1094-1104 ; discussion 1104-1105
• 57 Wasan SM, Ross WA, Staerkel GA et al. Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol 2005; 100: 2056-2061
• 58 Siriwardana HPP, Siriwardena AK. Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture. Ann Surg 2005; 242: 10-19
• 59 Cannon ME, Carpenter SL, Elta GH et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999; 50: 27-33
• 60 Fusaroli P, Manta R, Fedeli P et al. The influence of endoscopic biliary stents on the accuracy of endoscopic ultrasound for pancreatic head cancer staging. Endoscopy 2007; 39: 813-817
• 61 Kaassis M, Boyer J, Dumas R et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 2003; 57: 178-182
• 62 Catalano MF, Geenen JE, Lehman GA et al. “Tannenbaum” Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture. Gastrointest Endosc 2002; 55: 354-358
• 63 Prat F, Chapat O, Ducot B et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 1998; 47: 1-7
• 64 Knyrim K, Wagner HJ, Pausch J et al. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993; 25: 207-212
• 65 Allison MC, Sandoe JAT, Tighe R et al. Antibiotic prophylaxis in gastrointestinal endoscopy. Gut 2009; 58: 869-880
• 66 Dumonceau J-M, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998; 30: S80
• 67 Dumonceau J-M, Andriulli A, Deviere J et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010; 42: 503-515
• 68 Dumonceau J-M, Rigaux J, Kahaleh M et al. Prophylaxis of post-ERCP pancreatitis: a practice survey. Gastrointest Endosc 2010; 71: 934-939
• 69 Cotton P, Garrow D, Gallagher J et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88
• 70 Boustière C, Veitch AM, Vanbiervliet G et al. Endoscopy and antiplatelet agents. ESGE Guideline. Endoscopy 2011; 43: 445-61
• 71 Van Os EC, Kamath PS, Gostout CJ et al. Gastroenterological procedures among patients with disorders of hemostasis: evaluation and management recommendations. Gastrointest Endosc 1999; 50: 536-543
• 72 Veitch AM, Baglin TP, Gershlick AH et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut 2008; 57: 1322-1329
• 73 Arhan M, Odemiş B, Parlak E et al. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 2009; 23: 769-775
• 74 Ho H, Mahajan A, Gosain S et al. Management of complications associated with partially covered biliary metal stents. Dig Dis Sci 2010; 55: 516-522
• 75 Traina M, Tarantino I, Barresi L et al. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: A preliminary study. Liver Transpl 2009; 15: 1493-1498
• 76 Familiari P, Bulajic M, Mutignani M et al. Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc 2005; 62: 903-910
• 77 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
• 78 Bueno JT, Gerdes H, Kurtz RC. Endoscopic management of occluded biliary Wallstents: a cancer center experience. Gastrointest Endosc 2003; 58: 879-884
• 79 Rogart JN, Boghos A, Rossi F et al. Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center. Gastrointest Endosc 2008; 68: 676-682
• 80 Tham TC, Carr-Locke DL, Vandervoort J et al. Management of occluded biliary Wallstents. Gut 1998; 42: 703-707
• 81 Cho JH, Jeon TJ, Park JY et al. Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. Surg Endosc 2011; 25: 475-482
• 82 Togawa O, Kawabe T, Isayama H et al. Management of occluded uncovered metallic stents in patients with malignant distal biliary obstructions using covered metallic stents. J Clin Gastroenterol 2008; 42: 546-549
• 83 Fumex F, Coumaros D, Napoleon B et al. Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy 2006; 38: 787-792
• 84 Ornellas LC, Stefanidis G, Chuttani R et al. Covered Wallstents for palliation of malignant biliary obstruction: primary stent placement versus reintervention. Gastrointest Endosc 2009; 70: 676-683
• 85 Suk KT, Kim HS, Kim JW et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006; 64: 522-529
• 86 Yoon WJ, Lee JK, Lee KH et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc 2006; 63: 996-1000
• 87 Isayama H, Kawabe T, Nakai Y et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2006; 4: 1148-1153
• 88 Gosain S, Bonatti H, Smith L et al. Gallbladder stent placement for prevention of cholecystitis in patients receiving covered metal stent for malignant obstructive jaundice: a feasibility study. Dig Dis Sci 2010; 55: 2406-2411
• 89 Akamatsu N, Sugawara Y, Osada H et al. Diagnostic accuracy of multidetector-row computed tomography for hilar cholangiocarcinoma. J Gastroenterol Hepatol 2010; 25: 731-737
• 90 Park HS, Lee JM, Choi J-Y et al. Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. AJR Am J Roentgenol 2008; 190: 396-405
• 91 Choi J-Y, Kim M-J, Lee JM et al. Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 2008; 191: 1448- 1457
• 92 Masselli G, Manfredi R, Vecchioli A et al. MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol 2008; 18: 2213-2221
• 93 Fritscher-Ravens A, Broering DC, Knoefel WT et al. EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. Am J Gastroenterol 2004; 99: 45-51
• 94 Larghi A, Lecca PG, Ardito F et al. Evaluation of hilar biliary strictures by using a newly developed forward-viewing therapeutic echoendoscope: preliminary results of an ongoing experience. Gastrointest Endosc 2009; 69: 356-360
• 95 Lee SH, Park JK, Yoon WJ et al. Optimal biliary drainage for inoperable Klatskin’s tumor based on Bismuth type. World J Gastroenterol 2007; 13: 3948-3955
• 96 Saluja SS, Gulati M, Garg PK et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol 2008; 6: 944-950 e943
• 97 Paik WH, Park YS, Hwang J-H et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc 2009; 69: 55-62
• 98 Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998; 47: 354-362
• 99 Geller A. Klatskin tumor – palliative therapy: the jury is still out or may be not yet in. Gastrointest Endosc 2009; 69: 63-65
• 100 Cotton PB. Income and outcome metrics for the objective evaluation of ERCP and alternative methods. Gastrointest Endosc 2002; 56: 283-290
• 101 Vogl TJ, Schwarz WO, Heller M et al. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol 2006; 16: 2317-2325
• 102 Cha JH, Han JK, Kim TK et al. Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability. Abdom Imaging 2000; 25: 500-507
• 103 Muggli D, Müller MA, Karlo C et al. A simple method to approximate liver size on cross-sectional images using living liver models. Clin Radiol 2009; 64: 682-689
• 104 Hintze RE, Abou-Rebyeh H, Adler A et al. Magnetic resonance cholangiopancreatography-guided unilateral endoscopic stent placement for Klatskin tumors. Gastrointest Endosc 2001; 53: 40-46
• 105 Vienne A, Hobeika E, Gouya H et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72: 728-735
• 106 Deviere J, Baize M, de Toeuf J et al. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 1988; 34: 95-101
• 107 Polydorou AA, Chisholm EM, Romanos AA et al. A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. Endoscopy 1989; 21: 266-271
• 108 Freeman ML, Overby C. Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 2003; 58: 41-49
• 109 Singh V, Singh G, Verma GR et al. Contrast-free unilateral endoscopic palliation in malignant hilar biliary obstruction: new method. J Gastroenterol Hepatol 2004; 19: 589-592
• 110 Inal M, Akgül E, Aksungur E et al. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 2003; 14: 1409-1416
• 111 Naitoh I, Ohara H, Nakazawa T et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol 2009; 24: 552-557
• 112 Banerjee S, Shen B, Baron TH et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2008; 67: 791-798
• 113 Wagner HJ, Knyrim K, Vakil N et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 1993; 25: 213-218
• 114 Perdue DG, Freeman ML, Disario JA et al. Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol 2008; 42: 1040-1046
• 115 Nguyen-Tang T, Dumonceau J-M. A new method to facilitate bilateral hepatic duct drainage: simultaneous insertion of two thin 6-Fr self-expandable metal stents. Endoscopy 2011; 43 (Suppl. 02) E24-E25
• 116 Saleem A, Baron TH, Gostout CJ. Large-diameter therapeutic channel duodenoscope to facilitate simultaneous deployment of side-by-side self-expandable metal stents in hilar cholangiocarcinoma. Gastrointest Endosc 2010; 72: 628-631
• 117 Ortner MEJ, Caca K, Berr F et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003; 125: 1355-1363
• 118 Zoepf T, Jakobs R, Arnold JC et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol 2005; 100: 2426-2430
• 119 Gerhardt T, Rings D, Höblinger A et al. Combination of bilateral metal stenting and trans-stent photodynamic therapy for palliative treatment of hilar cholangiocarcinoma. Z Gastroenterol 2010; 48: 28-32
• 120 Wang L-W, Li L-B, Li Z-S et al. Self-expandable metal stents and trans-stent light delivery: are metal stents and photodynamic therapy compatible?. Lasers Surg Med 2008; 40: 651-659
• 121 Dumonceau JM, Devière J. Self-expandable metal stents. Baillieres Best Pract Res Clin Gastroenterol 1999; 13: 109-130
• 122 van Boeckel PGA, Vleggaar FP, Siersema PD. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterology 2009; 9: 96
• 123 Catalano MF, Linder JD, George S et al. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest Endosc 2004; 60: 945-952
• 124 Draganov P, Hoffman B, Marsh W et al. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest Endosc 2002; 55: 680-686
• 125 Pozsár J, Sahin P, László F et al. Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents. J Clin Gastroenterol 2004; 38: 118-123
• 126 Nguyen-Tang T, Dumonceau J-M. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol 2010; 24: 281-298
• 127 Kuzela L, Oltman M, Sutka J et al. Prospective follow-up of patients with bile duct strictures secondary to laparoscopic cholecystectomy, treated endoscopically with multiple stents. Hepato-Gastroenterology 2005; 52: 1357-1361
• 128 Morelli G, Fazel A, Judah J et al. Rapid-sequence endoscopic management of posttransplant anastomotic biliary strictures. Gastrointest Endosc 2008; 67: 879-885
• 129 Costamagna G, Tringali A, Mutignani M et al. Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up. Gastrointest Endosc 2010; 72: 551-557
• 130 Tabibian JH, Asham EH, Han S et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc 2010; 71: 505-512
• 131 Behm B, Brock A, Clarke BW et al. Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis. Endoscopy 2009; 41: 547-551
• 132 Chaput U, Scatton O, Bichard P et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc 2010; 72: 1167-1174
• 133 Kahaleh M, Behm B, Clarke BW et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc 2008; 67: 446-454
• 134 Sauer B, Regan K, Srinivasan I et al. Placement of covered self-expandable metal stents (CSEMS) in benign biliary strictures (BBS): eight years of experience. Gastrointest Endosc 2010; 71: AB110-AB111
• 135 Kiehne K, Fölsch UR, Nitsche R. High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance. Endoscopy 2000; 32: 377-380
• 136 Mahajan A, Ho H, Sauer B et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video). Gastrointest Endosc 2009; 70: 303-309
• 137 Cahen DL, Rauws EA, Gouma DJ et al. Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy 2008; 40: 697-700
• 138 Bourke MJ, Elfant AB, Alhalel R et al. Sphincterotomy-associated biliary strictures: features and endoscopic management. Gastrointest Endosc 2000; 52: 494-499
• 139 Costamagna G, Pandolfi M, Mutignani M et al. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 2001; 54: 162-168
• 140 Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol 2002; 97: 2763-2767
• 141 Sandha GS, Bourke MJ, Haber GB et al. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc 2004; 60: 567-574
• 142 Aksoz K, Unsal B, Yoruk G et al. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. Dig Endosc 2009; 21: 158-161
• 143 Llach J, Bordas JM, Elizalde JI et al. Sphincterotomy in the treatment of biliary leakage. Hepato-Gastroenterology 2002; 49: 1496-1498
• 144 Marks JM, Ponsky JL, Shillingstad RB et al. Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks. Surg Endosc 1998; 12: 327-330
• 145 Katsinelos P, Kountouras J, Paroutoglou G et al. A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc 2008; 22: 101-106
• 146 Coté GA, Ansstas M, Shah S et al. Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks. Surg Endosc 2010; 24: 1752-1756
• 147 Bergman JJ, Rauws EA, Tijssen JG et al. Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc 1995; 42: 195-201
• 148 Chan AC, Ng EK, Chung SC et al. Common bile duct stones become smaller after endoscopic biliary stenting. Endoscopy 1998; 30: 356-359
• 149 Han J, Moon JH, Koo HC et al. Effect of biliary stenting combined with ursodeoxycholic acid and terpene treatment on retained common bile duct stones in elderly patients: a multicenter study. Am J Gastroenterol 2009; 104: 2418-2421
• 150 Pisello F, Geraci G, Li Volsi F et al. Permanent stenting in “unextractable” common bile duct stones in high risk patients. A prospective randomized study comparing two different stents. Langenbecks Arch Surg 2008; 393: 857-863
• 151 Jain SK, Stein R, Bhuva M et al. Pigtail stents: an alternative in the treatment of difficult bile duct stones. Gastrointest Endosc 2000; 52: 490-493
• 152 Horiuchi A, Nakayama Y, Kajiyama M et al. Biliary stenting in the management of large or multiple common bile duct stones. Gastrointest Endosc 2010; 71: 1200-1203 e1202
• 153 Katsinelos P, Kountouras J, Paroutoglou G et al. Combination of endoprostheses and oral ursodeoxycholic acid or placebo in the treatment of difficult to extract common bile duct stones. Dig Liver Dis 2008; 40: 453-459
• 154 Somerville KW, Ellis WR, Whitten BH et al. Stones in the common bile duct: experience with medical dissolution therapy. Postgrad Med J 1985; 61: 313-316