Temporary sphincter-preserving covered biliary stent: a novel adjunctive device for cholangioscopy-guided calculi clearance

To date, cholangioscopy-guided calculi clearance has become a well-established treatment method for common bile duct (CBD) calculi [1] [2]. However, these procedures typically require endoscopic sphincterotomy (EST), which might lead to the loss of sphincter of Oddi (SO) function and some adverse events, including bleeding, perforation, cholangitis, and calculi recurrence [3]. Importantly, EST was not appropriate for those patients who could not stop taking anticoagulation/antiplatelet agents. Therefore, multiple investigators – including our team – have pioneered the deployment of a self-expandable metal stent (SEMS) prior to calculi clearance as an alternative sphincter-preserving strategy [4] [5]. However, clinical experience reveals that calculi frequently become lodged between the SEMS and biliary wall ([Fig. 1]), presenting a critical limitation to the widespread adoption of this strategy.