In Reply I agree with Dr Costamagna that currently available designs for fully covered, self-expandable metallic stents limit their utility to patients in whom the stricture is below the hepatic confluence and when the surrounding bile duct diameter is large enough to accommodate the device. In the trial, patients whose unaffected bile duct was less than 6 mm were excluded to avoid secondary duct injuries and higher rates of spontaneous stent migration. Additional comparative safety data for self-expandable metallic stents are needed for patients who have not undergone a cholecystectomy, which predominantly applies to those having bile duct strictures in the setting of chronic pancreatitis. These limitations may spur development of expandable stents designed to address these subgroups while minimizing the need for multiple interventions.
Coté GA. Metallic vs Plastic Stents for Benign Biliary Strictures—Reply. JAMA. 2016;316(5):540-541. doi:10.1001/jama.2016.7306