Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction

Background: Self-expanding metallic stents are widely used for relieving biliary duct obstruction in patients with unresectable periampullary malignancies. However, only a few studies have assessed the occurrence of fractures in these stents. Purpose: To determine the prevalence and significance of stent fracture after placement of self-expanding metallic stents for periampullary malignant biliary obstruction. Material and Methods: Over a 5-year period, 48 patients underwent placement of self-expanding metallic stents for periampullary malignant biliary obstructions. Stents were introduced 2–6 weeks after a percutaneous transhepatic biliary decompression. The medical records and relevant images were reviewed for stent patency, stent fracture, type of stent, and stent-related complications. Results: Stent fracture was detected in four of the 48 patients (8%): in one patient at 1 month and in three patients between 10 and 21 months after stenting. All four fractures involved one type of nitinol stent used in 38 patients. In one of the patients, fracture was complicated by life-threatening gastrointestinal bleeding. The mean survival time for all patients was 251 days (standard deviation [SD]±275 days) and the mean overall patency time for all stents was 187 days (SD±205 days). Conclusion: Stent fracture occurs after placement of self-expanding nitinol stents for periampullary malignant biliary obstruction. The low reported incidence of this complication may be due to a lack of awareness of and difficulty in detecting stent fracture. Fracture should be considered as a possible contributing factor in recurrent biliary obstruction after self-expanding metallic stent insertion.

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Self-Expanding Metallic Stent Fracture in the Treatment of Malignant Biliary Obstruction

Gastroenterology Research and Practice ◽

10.1155/2018/6527879 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10

Author(s):

Chuanguo Zhou ◽

Baojie Wei ◽

Jianfeng Wang ◽

Qiang Huang ◽

Hui Li ◽

...

Keyword(s):

Clinical Features ◽

Biliary Obstruction ◽

Balloon Dilation ◽

Malignant Biliary Obstruction ◽

Stent Fracture ◽

Metallic Stent ◽

Survival Times ◽

Stent Deployment ◽

Stent Patency ◽

Stent Occlusion

Background. Palliative therapies for malignant biliary obstruction (MBO) include choledochojejunostomy and self-expanding metallic stent (SEMS) insertion. Fractures following SEMS insertion in MBO treatment are scarce. Objective. To assess the clinical features of biliary stent fractures and evaluate associated factors. Methods. One hundred fifty-six consecutive patients who underwent biliary SEMS placement for MBO treatment at Beijing Chaoyang Hospital affiliated to Capital Medical University, in 2010–2015, were evaluated retrospectively. Demographics, clinical features, stent parameters and patency times, and survival times were collected. Across the ampulla of Vater, balloon dilatation, number of stents, stent patency time, and survival time were compared between the stent and nonstent fracture groups. Results. There were 168 biliary metallic stents inserted in 156 patients, including 144 and 12 patients with one and 2-3 stents, respectively. Pre- and/or postballoon dilation was performed in 107 patients. Stents across and above the duodenal papilla were used in 105 and 51 patients, respectively. Six cases (3.8%) with stent occlusion had stent fractures. Single- and multiple-stent fracture rates were 4/144 (2.8%) and 2/12 (16.7%), respectively. Fracture times after stent deployment were 126.8 ± 79.0 (median, 115.5) days. Stent patency times in the stent and nonstent fracture groups were 151.8 ± 67.8 (median, 160.5) days and 159.3 ± 73.6 (median, 165.5) days, respectively. Overall survival times in the stent and nonstent fracture groups were 399.7 ± 147.6 (median, 364.0) days and 283.7 ± 126.1 (median, 289.0) days, respectively. Conclusion. Stent fractures following MBO treatment constitute a relatively rare long-term complication. Though there were no factors found to be significantly associated with SEMSs fracture, a trend could be observed towards more fractures in multistent, transpapillary, and balloon dilation groups.

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Biliary self-expandable metallic stent combined with Iodine-125 seeds strand in the treatment of hilar malignant biliary obstruction

Journal of International Medical Research ◽

10.1177/0300060519887843 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051988784

Author(s):

Chuanguo Zhou ◽

Hui Li ◽

Qiang Huang ◽

Jianfeng Wang ◽

Kun Gao

Keyword(s):

Overall Survival ◽

Biliary Obstruction ◽

Median Overall Survival ◽

Malignant Biliary Obstruction ◽

Group Differences ◽

Complication Rates ◽

Metallic Stent ◽

Stent Patency ◽

Expandable Metallic Stent ◽

Iodine 125

Objective To assess the safety and effectiveness of a self-expandable metallic stent (SEMS) combined with Iodine-125 seeds strand to treat hilar malignant biliary obstruction (MBO). Methods This retrospective study included patients who had received SEMS with 125I seeds strand (seeds group) or SEMS alone (controls) to treat hilar MBO. Demographic, biochemical, stent patency, overall survival and complications data were extracted and analysed. Results A total of 76 patients were included (seeds group, n = 40; controls, n = 36), with a total of 608 seeds deployed in the seeds group (mean, 15.2 ± 4.1 [range, 8–25] seeds per patient). Statistically significant between-group differences were shown in median stent patency time (seeds group, 387.0 ± 27.9 days [95% confidence interval {CI} 332.4, 441.6] versus controls, 121.0 ± 9.1 days [95% CI 103.2, 138.8]) and in median overall survival (seeds group, 177.0 ± 17.9 days [95% CI 141.8, 212.2] versus controls, 123.0 ± 20.4 [95% CI 83.0, 163.0]). There were no statistically significant between-group differences in complication rates. Conclusion SEMS combined with 125I seeds strand is safe, feasible, and tolerable in treating patients with hilar MBO, and may be effective in prolonging stent patency time and overall survival.

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A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures

Endoscopy International Open ◽

10.1055/s-0043-110566 ◽

2017 ◽

Vol 05 (07) ◽

pp. E635-E641 ◽

Cited By ~ 1

Author(s):

Lachlan Ayres ◽

Danny Cheriyan ◽

Ryan Scott ◽

Edward Kim ◽

Terry Lee ◽

...

Keyword(s):

Clinical Trials ◽

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Conventional Group ◽

Plastic Stents ◽

Stent Insertion ◽

Endoscopic Retrograde ◽

Stent Patency ◽

Plastic Stent ◽

Blinded Trial

Abstract Background and study aims Stent insertion at endoscopic retrograde cholangiopancreatography (ERCP) is an established therapy for managing malignant biliary obstruction. Conventional plastic stents with a tubular design are most commonly used despite limited patency. Plastic stents with a winged design may theoretically increase the duration of stent patency. The aim of this study was to compare stent patency of the winged versus conventional plastic stents in patients with malignant biliary obstruction. Patients and methods A prospective, randomized subject-blinded trial was conducted. Patients with malignant biliary obstruction were randomized (1:1) to either a 10 French winged stent or 7 or 10 French conventional plastic stent. Strictures greater than 1 cm distal to the hilum were included. Patients were followed clinically to determine the frequency of stent failure until surgery, death or study closure. Results Fifty-eight patients were enrolled. Following 9 exclusions, 49 patients were randomized to a winged (n = 23) or conventional stent (n = 26). Median time to stent failure was 89 (95 % CI 26-NA) vs 143 (95 % CI 33 – 266) days (P = 0.963) for the winged and conventional group, respectively. Stent failure for the winged group occurred in 11 (48 %) compared to 14 (54 %) in the conventional group. Median survival was 123 (95 % CI 81 – 189) vs 342 days (95 % CI 123 – 704) (p = 0.084) in the winged and conventional group respectively. There were no procedure related adverse events. Conclusions Improvement in stent patency was not seen with the winged stent when compared to the conventional plastic stent. Clinical trials number NCT01514214.

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Early Infectious Complications of Percutaneous Metallic Stent Insertion for Malignant Biliary Obstruction

American Journal of Roentgenology ◽

10.2214/ajr.09.2474 ◽

2010 ◽

Vol 194 (1) ◽

pp. 261-265 ◽

Cited By ~ 14

Author(s):

Yu Li Sol ◽

Chang Won Kim ◽

Ung Bae Jeon ◽

Nam Kyung Lee ◽

Suk Kim ◽

...

Keyword(s):

Biliary Obstruction ◽

Infectious Complications ◽

Malignant Biliary Obstruction ◽

Stent Insertion ◽

Metallic Stent

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Unresectable Malignant Biliary Obstruction: Treatment by Self-Expandable Biliary Endoprostheses

HPB Surgery ◽

10.1155/1993/78590 ◽

1993 ◽

Vol 6 (3) ◽

pp. 175-184 ◽

Cited By ~ 13

Author(s):

Andreas Glättli ◽

Steven C. Stain ◽

Hans U. Baer ◽

Walter Schweizer ◽

Jürgen Triller ◽

...

Keyword(s):

Biliary Obstruction ◽

Randomized Study ◽

Malignant Biliary Obstruction ◽

Plastic Stents ◽

Stent Patency ◽

Stent Occlusion ◽

Primary Tumors ◽

Malignant Obstruction ◽

The Mean ◽

Biliary Endoprostheses

The primary goal in the treatment of malignant obstruction is the relief of jaundice. Although operative biliary bypass is a reliable method of palliation, nonoperative palliation may be desirable in selected patients.We report our experience with forty-eight self expandable metallic biliary endoprostheses (Wallstent) percutaneously placed in 35 patients with irresectable malignant biliary obstruction. In twelve patients more than one stent was necessary to bridge the entire length of the biliary stenosis. The obstruction was due to primary tumors in 14 and to lymph node metastases in 12. In nine patients transanastomotic stents were placed after previous bilioenteric anastomosis because of malignant obstruction. Complications occurred in 11 patients (31.4%), and five patients died within 30 days of stent placement (14.3%). The mean stent patency to date of patients discharged is 6.1 months, and the mean survival 7.2 months. Follow up data is available for 29 patients, and excellent palliation was achieved for more than 75% of the survival time in 22 (76%). Seven patients have had documented stent occlusion requiring further intervention (24%).In this selected group of patients, the results of percutaneous self-expandable stents are encouraging. However, our data does not support the initial reports of self-expandable endoprostheses that suggest an improved result compared to conventional plastic stents. A randomized study using either expandable stents as compared to operative biliary enteric bypass is necessary.

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Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents

Acta Radiologica ◽

10.1177/0284185120911187 ◽

2020 ◽

Vol 61 (12) ◽

pp. 1591-1599

Author(s):

Aboelyazid Elkilany ◽

Mohamed Alwarraky ◽

Dominik Geisel ◽

Mohamed A Maaly ◽

Timm Denecke

Keyword(s):

Biliary Obstruction ◽

Palliative Treatment ◽

Patient Survival ◽

Randomized Study ◽

Malignant Biliary Obstruction ◽

Metallic Stents ◽

Stent Patency ◽

Uncovered Stents ◽

Significant Difference ◽

Expandable Metallic Stents

Background Considering the limitations in both uncovered self-expandable metallic stents (USEMS) and covered self-expandable metallic stents (CSEMS), it is difficult to make a general recommendation for their application in percutaneous decompression of malignant biliary obstruction (MBO). Purpose To compare percutaneous transhepatic CSEMSs versus USEMSs for the palliative treatment of MBO in terms of technical success, clinical success, stent patency, patient survival, complications, and stent dysfunction. Material and Methods This prospective randomized study included 66 patients with unresectable MBO. CSEMSs were inserted in 31 patients (26 men, 5 women; mean age = 63.8 ± 7.96 years) and USEMSs were inserted in 35 patients (26 men, 9 women; mean age = 62.3 ± 11.7 years). Results Mean primary stent patency duration was 138 ± 92.7 days in CSEMSs versus 150 ± 77.9 days in USEMSs ( P = 0.578). Tumor overgrowth occurred exclusively in one patient with CSEMS ( P = 0.470) and tumor ingrowth exclusively in two patients with USEMS ( P = 0.494). Stent migration occurred in two patients with CSEMSs versus one patient with USEMSs ( P = 0.579). Hemobilia occurred in five patients with CSEMSs versus three patients with USEMSs while bile leakage occurred in one patient in each group despite the larger introducer sheath caliber with CSEMSs (9 F vs. 6–7 F). There was no significant difference regarding patient survival ( P = 0.969). Conclusion In our cohort of patients with rather poor life expectancy, there was no significant difference between covered and uncovered stents for the palliative treatment of MBO. However, considering the higher cost of CSEMs and the larger introducer diameter necessary for their placement, USEMSs can be preferred.

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Covered and Uncovered Self-Expandable Metallic Stents in the Treatment of Malignant Biliary Obstruction

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.99928 ◽

2020 ◽

Vol 22 (7) ◽

Author(s):

Lian-Biao Li ◽

Wen-Yan Qin ◽

Wen-Ping Peng ◽

Jin-Zhen Li ◽

Ming-Ming Zhang ◽

...

Keyword(s):

Biliary Obstruction ◽

Meta Analysis ◽

Malignant Biliary Obstruction ◽

Metallic Stents ◽

Metal Stents ◽

Stent Patency ◽

Advantages And Disadvantages ◽

Study Results ◽

Significant Difference ◽

Expandable Metallic Stents

Context: Self-expandable metal stents (SEMSs) are commonly used in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant distal biliary obstruction. Methods: A comprehensive search was conducted using PubMed, Embase, Cochrane, and CNKI databases from 2010 to 2019. All randomized controlled trials, which compared the use of the CSEMSs and UCSEMSs for the treatment of malignant distal biliary obstruction were included in this study. Results: This meta-analysis included 1,539 patients enrolled in 13 trials. There was no difference between the two groups in terms of patients’ survival (hazard ratio (HR) 0.96, 95% confidence interval (CI): 0.87 - 1.07; I2 = 32.6%), stent patency (HR 0.92, 95% CI: 0.69 - 1.22; I2 = 56.3%), and the overall complication rate (relative risks (RR) 1.35, 95% CI: 0.82 - 2.23; I2 = 0%). In particular, the CSEMSs group presented a lower rate of tumor ingrowth (RR 0.30, 95% CI: 0.15 - 0.57; I2 = 58.5%) than the UCSEMSs group. However, the CSEMSs group exhibited a higher rate of tumor overgrowth (RR 1.63, 95% CI: 1.00 - 2.66; I2 = 0%), sludge formation (RR 2.28, 95% CI: 1.36 - 3.82; I2 = 0%), and migration (RR 5.14, 95% CI: 1.90 - 13.88; I2 = 0%). Conclusions: Our meta-analysis indicated that there was no significant difference between the two stents, and each one had its advantages and disadvantages.

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