SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 61 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Metal Stents Self-Expanding Metal Stents (SEMS) are divided into uncovered (sometimes called ‘bare’), or partially covered stents (USEMS, PCSEMS) and fully-covered stents (FCSEMS). This means that the mesh of the stent is covered to a varying degree by a plastic covering. Uncovered stents or partially covered stents are used when a stent is placed across a stricture permanently and are designed not to be removed or fall out. They reach their maximum diameter over a period of days and the wall of the bile duct will grow into the mesh of the stent after only a day or two, making them impossible to remove. Partially covered stents are designed so there is no tumour ingrowth through the walls of the stent causing it to block off, but this makes the stent slippery and so the ends of the stent that flare out (the ‘flanges’) are uncovered, and grow into the walls of the bile duct so that it doesn’t slip out. The proximal flange of the stent usually protrudes out of the bottom of the ampulla into the duodenum so that the stent can be accessed and cleaned out if necessary in the future, and the length of the stent depends on how long the stricture is. When stenting high up in the bile ducts, uncovered stents are used to prevent blocking off side branches of the bile ducts by accident. Similar care must be taken to prevent blocking the opening of the cystic duct with the covered portion of partially covered stents. Sometimes stents are placed into both intrahepatic ducts in a Y shape when the blockage is at the bifurcation of the bile ducts. In this case the stents used are USEMS but on a ultra-narrow delivery system to allow both stents to be deployed simultaneously. Fully Covered Metal Stents are temporary stents that are inserted to manage benign strictures, to cover up perforations in the bile ducts and also to press against tiny bleeding points after sphincterotomy. They are relatively easy to place and are designed so that the mesh does not embed itself too far into the lining of the bile ducts. This allows them to be removed by grasping the yellow lasso with grasping forceps and pulling the stent up into the endoscope. They can stay in place for up to a year, but do have a habit of falling out of position. 3 5 ! 99 Biliary/Pancreatic - Metal Stents Cook Medical Evolution® Biliary Controlled-Release Stent - Partially Covered Not for sale in the USA. Used in palliation of malignant neoplasms in the biliary tree. Order Number Reference Part Number Introducer Size Fr Body Diameter mm Stent Flange Diameter mm Stent Length cm Wire Guide Diameter inch MR Status Minimum Accessory Channel mm G23136 EVO-PC-8-9-6-B* 8.5 8 9 6 .035 3.2 G23137 EVO-PC-8-9-8-B* 8.5 8 9 8 .035 3.2 G23138 EVO-PC-10-11-4-B* 8.5 10 11 4 .035 3.2 G23139 EVO-PC-10-11-6-B* 8.5 10 11 6 .035 3.2 G23140 EVO-PC-10-11-8-B* 8.5 10 11 8 .035 3.2 Some products or part numbers may not be available in all markets. Contact your local Cook representative or Customer Service for details regarding: stock/non-stock status (expect longer lead time if non-stock), pricing and/or availability. Warning: The safety and e ectiveness of this device for use in the vascular system have not been established. *Check for availability. ! Biliary/Pancreatic - Metal Stents Evoluti Fully C Not for s Used in ! Evoluti Uncove Used in Order Number Reference Part Number Introducer Size Fr Body Diameter mm G23123 EVO-8-9-4-B 8.5 8 G23124 EVO-8-9-6-B 8.5 8 G23125 EVO-8-9-8-B 8.5 8 G23126 EVO-8-9-10-B 8.5 8 G23127 EVO-10-11-4-B 8.5 10 G23128 EVO-10-11-6-B 8.5 10 G23129 EVO-10-11-8-B 8.5 10 G23130 EVO-10-11-10-B 8.5 10 Some products or part numbers may not be available in all markets. Contact your Biliary/Pancreatic - Metal Stents Order Number Reference Part Number Stent Diameter mm Stent Length cm Introducer Size Fr Introducer Length cm Wire Guide Diameter inch MR Status Minimum Accessory Channel mm Zilv r® Biliary Self-Expanding Stent Used in palliation of malignant neoplasms in the biliary tree.