Future developments in biliary stenting

Abstract

Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting.

Keywords: benign biliary strictures; bioabsorbable stents; drug eluting stents; malignant biliary strictures; plastic stents; self-expandable metal stents.

Figure 1

Bonastent M-hilar stent (Standard Sci Tech, Seoul, Korea). Note: The more loosely woven center portion is centered at the hilum to facilitate placement of the second (contralateral) stent through the mesh.

Figure 2

Placement (A and B) and then removal (C) of a fully covered metal stent after 6-month indwell time in a liver transplant patient with an anastomotic stricture.

Figure 3

Epithelial hyperplasia surrounding a fully covered metal stent after 3-month indwell time in a patient with benign biliary stricture secondary to chronic pancreatitis.