Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography

Abstract

Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents.

Keywords: Biliary stent; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography; Pancreatic stent; Self-expandable metal stent.

Figure 1

A display of different types of biliary plastic stents available.

Figure 2

A display of different types of biliary self-expandable metal stents available. The Evolution (A) uncovered stent, Cook Endoscopy, the Wallflex (B) partially covered stent, Boston Scientific, and the SHC (C) fully covered stent, Hanaro MI Tech.

Figure 3

The Viabil (A) fully covered stent, Gore Medical, and the Wallflex (B) fully covered stent, Boston Scientific.

Figure 4

The Bumpy Niti-S stent (A), Taewoong Medical and The BCT stent (B), Hanaro MI Tech.

Figure 5

The BPE stent (A), Hanaro MI Tech, and the Giobor Niti-S stent (B), Taewoong Medical.

Figure 6

A display of different types of lumen apposing metal stents available: The AXIOS (A) stent, Boston Scientic, the Spaxus (B) and NAGI (C) Niti-S stents, Taewoong Medical, the Aix (D) stent, Leufen Medical, and the BCF (E) stent, Hanaro MI Tech.

Figure 7

A display of different types of pancreatic plastic stents available.

Figure 8

Traditional transluminal endoscopic drainage of pancreatic fluid collections. PFC: Pancreatic fluid collections.