Efficacy and Safety of Temporary Fully Covered Self-Expandable Metal Stents for High-Grade Biliary Strictures in Primary Sclerosing Cholangitis: A Single-Center Retrospective Case Series.

BACKGROUND AND AIMS: High-grade strictures are a frequent and clinically significant complication in patients with primary sclerosing cholangitis (PSC). Conventional endoscopic therapies, such as balloon dilatation and plastic stenting, often yield only temporary or suboptimal results. Evidence regarding long-term outcomes following the temporary insertion of fully covered self-expandable metal stents (FC-SEMS) remains limited. This case series aimed to evaluate the efficacy and safety of FC-SEMS in patients with high-grade strictures unresponsive to standard endoscopic management. METHODS: We retrospectively analyzed seven PSC patients who underwent FC-SEMS placement for refractory high-grade stricture between 2018 and 2023. The primary endpoints included technical success, clinical improvement, resolution or recurrence of high-grade stricture, and procedure-related adverse events. Biochemical markers and symptom profiles were assessed before and after intervention. RESULTS: Technical success for both stent deployment and removal was 100%. The median indwelling time was 30 days (range: 7-90), with a median post-removal follow-up of 26 months (range: 12-48). Stricture resolution was achieved in six patients (85.7%), with one experiencing recurrence requiring repeat stenting. No procedure-related complications were observed. All symptomatic patients reported resolution of pruritus and fatigue. Significant improvements in AST (p=0.02), ALP (p=0.041), and GGT (p=0.039) were documented. CONCLUSION: Temporary FC-SEMS placement appears to be a safe and effective therapeutic option for selected PSC patients with high-grade stricture refractory to conventional endoscopic therapy.