Use of Fully Covered Self-Expanding Metal Biliary Stents in Pediatrics: A Case Series.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been utilized in this population for obstructive lesions and bile leaks, however they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. However, their use in pediatrics has not been defined. The aim of this study is to describe our experience with FCSEMS at our institution. Methods: We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including three adolescents and one young adult with complex medical needs. Results: Patient age range was 12-24 years and the weight ranged between 36-75 kg. All patients underwent previous ERCP and one or more rounds of plastic stenting without adequate clinical response prior to consideration of FCSEMS placement. Indications included: 1) Recalcitrant biliary anastomotic stricture post liver transplant, 2) Persistent bile leak after needle perforation, 3) Recurrent obstructive choledocholithiasis after cholecystectomy, and 4) Malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6-8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal. Conclusions: FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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