TIPS ON ENDOSCOPIC BILIARY STENTING USING ANTI-REFLUX METAL STENTS INCLUDING RE-INTERVENTION AFTER THE STENT OBSTRUCTION

Abstract

A concern of using metal stents to address biliary drainage is stent dysfunction induced by duodenal reflux; therefore, anti-reflux metal stent (ARMS) with anti-reflux valve (ARV) have been developed to solve this problem. Although various ARMS have been reported till date, the superiority over conventional metal stents have not been fully demonstrated. Therefore, further development for ARMS is indispensable. Biliary stenting using an ARMS is almost similar to that using the conventional metal stent; however, the metal part of the ARMS should be placed across the papilla to ensure the exposure of ARV in the duodenum. An ARMS needs to be exchanged when stent dysfunction occurs, as with the conventional metal stent. For cases with difficulties in ARMS extraction, additional stent placement utilizing a stent-in-stent technique or other biliary interventions, such as percutaneous drainage or transluminal drainage using endoscopic ultrasound, should be considered.