Temporary self-expandable metal stent placement for treatment of post-sphincterotomy bleeding

Background: Endoscopic sphincterotomy (ES) is a basic technique for performing therapeutic interventions during ERCP. Bleeding after ES is a recognized complication and can be difficult to treat. Objective: To evaluate the role of temporary placement of fully covered self-expandable metal stents (SEMSs) for the treatment of difficult-to-control post-ES hemorrhage. Design: Retrospective case series. Setting: Interventional endoscopy unit at a tertiary care referral hospital. Patients: Five patients treated with temporary SEMSs for difficult-to-control post-ES hemorrhage. Interventions: ERCP with placement of fully covered, biliary SEMSs and subsequent stent removal within 8 weeks. Main Outcome Measurements: Technical success of SEMS placement, clinical success with hemostasis, complications related to SEMS placement and removal. Results: Five patients were treated with temporary fully covered SEMSs for post-ES hemorrhage over an 8-month period. Hemostasis was achieved in all patients. Within 8 weeks of the procedure, the SEMSs were easily removed in 3 patients; the SEMSs had spontaneously migrated without incident in the other 2. No other complications were seen. Limitations: Retrospective series with a small number of patients. Conclusions: Temporary placement of fully covered SEMSs across the biliary orifice seems to be an effective treatment for post-ES hemorrhage. However, stent migration is a concern and may limit this therapy in certain settings.