Endoscopic Sphincterotomy before Fully Covered Metal Stent Placement Is Not Required for Distal Malignant Biliary Stricture due to a Pancreatic Head Tumor

Background/Aims. Endoscopic sphincterotomy (EST) is often performed before fully covered self-expandable metal stent (FCSEMS) placement in order to prevent pancreatitis. However, it is not clear whether EST prevents pancreatitis or affects other adverse events (AEs). This study is conducted to evaluate the necessity of EST before FCSEMS placement for distal malignant biliary strictures due to a pancreatic head tumor. Methods. This study included 68 patients who underwent FCSEMS placement for distal malignant biliary stricture due to a pancreatic head tumor. Treatment outcomes and AEs were retrospectively compared between 32 patients with EST before FCSEMS placement (EST group) and 36 patients without EST (non-EST group). Results. The success rates of drainage for the EST and non-EST groups were 100% and 97.2%, respectively (P=0.95). The incidence of pancreatitis in the EST and non-EST groups was 3.1% and 0%, respectively (P=0.95). The incidence of hyperamylasemia in the EST and non-EST groups was 12.5% and 13.9%, respectively (P=0.85). The incidence of all AEs in the EST and non-EST groups was 15.6% (pancreatitis: 1, cholecystitis: 2, and stent migration: 2) and 13.9% (cholecystitis: 3, stent migration: 2), respectively (P=0.89). Conclusions. EST before FCSEMS placement for distal malignant biliary stricture due to a pancreatic head tumor does not affect the successful drainage and incidence of adverse events. The necessity of EST to prevent pancreatitis before FCSEMS placement was deemed low.

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Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2010/903520 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Kei Ito ◽

Naotaka Fujita ◽

Yutaka Noda ◽

Go Kobayashi ◽

Takashi Obana ◽

...

Keyword(s):

Bile Duct ◽

Biliary Stricture ◽

Stent Migration ◽

Metal Stents ◽

Metal Stent ◽

First Case ◽

Node Metastases ◽

Duct Cancer ◽

Malignant Biliary Stricture ◽

Duct Stricture

We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low shortening ratio are expected to lessen the occurrence of complications characteristic of covered metal stents such as stent migration and bile duct kinking.

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Su1510 THE EFFICACY OF A FULLY COVERED SELF-EXPANDABLE METAL STENT ANCHORED BY A PLASTIC STENT FOR ANTI-MIGRATION IN THE MANAGEMENT OF MALIGNANT BILIARY STRICTURE: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.2225 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB357

Author(s):

Woo Hyun Paik ◽

Sang Hyub Lee ◽

Byeong Jun Song ◽

Sang Myung Woo ◽

Woo Jin Lee ◽

...

Keyword(s):

Biliary Stricture ◽

Randomized Controlled Study ◽

Controlled Study ◽

Metal Stent ◽

Plastic Stent ◽

Randomized Controlled ◽

Malignant Biliary Stricture ◽

Self Expandable Metal Stent

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Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy

Gastroenterology Report ◽

10.1093/gastro/goaa020 ◽

2020 ◽

Author(s):

Babatunde Olaiya ◽

Parit Mekaroonkamol ◽

Bai-Wen Li ◽

Julia Massaad ◽

Cicily T Vachaparambil ◽

...

Keyword(s):

Clinical Success ◽

Stent Migration ◽

Single Step ◽

Success Rates ◽

Metal Stent ◽

Technical Success ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

The Mean ◽

Fluid Collections

Abstract Background Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy. Methods Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded. Results A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures. Conclusions ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.

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Endoscopic side-by-side uncovered self-expandable metal stent placement for malignant hilar biliary obstruction

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774519846345 ◽

2019 ◽

Vol 12 ◽

pp. 263177451984634 ◽

Cited By ~ 1

Author(s):

Katsuya Kitamura ◽

Akira Yamamiya ◽

Yu Ishii ◽

Yuta Mitsui ◽

Hitoshi Yoshida

Keyword(s):

Adverse Events ◽

Stent Placement ◽

Biliary Obstruction ◽

Arterial Embolization ◽

Metal Stents ◽

Success Rates ◽

Metal Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

Aim: To investigate outcomes of endoscopic bilateral side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents for unresectable malignant hilar biliary obstruction. Methods: We retrospectively analyzed 23 patients who underwent endoscopic biliary uncovered self-expandable metal stent placement for unresectable malignant hilar biliary obstruction between January 2015 and September 2016 at our institution. We performed endoscopic side-by-side placement across the papilla using 10-mm-diameter longer-model uncovered self-expandable metal stents. Outcomes included the technical and functional success rates, recurrent biliary obstruction rate, time to recurrent biliary obstruction, reintervention rate, and incidence of adverse events other than recurrent biliary obstruction. Results: Of the 23 patients, 10 with malignant hilar biliary obstruction underwent endoscopic side-by-side uncovered self-expandable metal stent placement across the papilla (median age, 83 years; 6 men). The locations of malignant hilar biliary obstruction were Bismuth types II ( n = 3), III ( n = 3), and IV ( n = 4). The median common bile duct diameter was 8 mm. The technical and functional success rates were 100% and 80%, respectively. Seven patients (70%) developed recurrent biliary obstruction because of stent occlusions, including early hemobilia in two patients and late tumor ingrowth in five patients. The median time to recurrent biliary obstruction was 66 (95% confidence interval: 29–483) days. Six patients (60%) required reintervention, and 1 (10%) underwent transcatheter arterial embolization for right hepatic arterial pseudoaneurysm. Early adverse events other than recurrent biliary obstruction occurred in four patients and late adverse event in one patient. Conclusion: Endoscopic side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents was technically feasible for unresectable malignant hilar biliary obstruction; however, it might be better to avoid this method for patients with malignant hilar biliary obstruction because of high recurrent biliary obstruction rate and shorter time to recurrent biliary obstruction.

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Impact of palliative biliary drainage between metal stent and plastic stent on survival rate in unresectable distal malignant biliary stricture in south of Thailand

10.26226/morressier.59a6b342d462b80290b53f62 ◽

2017 ◽

Author(s):

Tanawat Pattarapuntakul

Keyword(s):

Survival Rate ◽

Biliary Drainage ◽

Biliary Stricture ◽

Metal Stent ◽

Plastic Stent ◽

Malignant Biliary Stricture

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A comparison of outcomes between a lumen-apposing metal stent with electrocautery-enhanced delivery system and a bi-flanged metal stent for drainage of walled-off pancreatic necrosis

Endoscopy International Open ◽

10.1055/s-0043-120831 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1189-E1196 ◽

Cited By ~ 5

Author(s):

Noor Bekkali ◽

Manu Nayar ◽

John Leeds ◽

Richard Charnley ◽

Matthew Huggett ◽

...

Keyword(s):

Adverse Events ◽

Delivery System ◽

Pancreatic Necrosis ◽

Clinical Success ◽

Stent Migration ◽

Metal Stents ◽

Procedure Time ◽

Metal Stent ◽

End Point ◽

Significant Difference

Abstract Background and study aims Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON), but their placement requires multiple steps and the use of other devices. More recently, a novel device consisting of a combined lumen-apposing metal stent (LAMS) and electrocautery-enhanced delivery system has been introduced. The aim of this study was to compare the placement and outcomes of the two devices. Patients and methods This was a retrospective review of consecutive patients undergoing endoscopic ultrasound-guided placement of BFMS or LAMS for drainage of symptomatic WON. Data from procedures between October 2012 and December 2016 were taken from a prospectively maintained database. We compared technical and clinical success, procedure time, costs, and composite end point of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS. Results 72 consecutive patients underwent placement of BFMS (40 patients, 44 stents) or LAMS (32 patients, 33 stents). Technical success was 91 % for BFMS and 97 % for LAMS. Clinical success was 65 % vs. 78 %, respectively. Median in-room procedure time was significantly shorter in the LAMS group (45 minutes [range 30 – 80]) than in the BFMS group (62.5 minutes [range 35 – 135]; P < 0.001) and fewer direct endoscopic necrosectomies (DEN) were performed (median 1 [0 – 2.0] vs. 2 [0 – 3.7], respectively; P = 0.005). If only inpatients were considered (35 BFMS and 19 LAMS), there was no significant difference in DEN 2 (range 0 – 11) and 2 (range 0 – 8), respectively. The composite end point of 32 % vs. 24 % was not significantly different. Median procedural costs for all patients with successful stent placement for WON treatment was €4427 (range 1630 – 12 926) for BFMS vs. €3500 (range 2509 – 13 393) for LAMS (P = 0.10). Conclusion LAMS was superior to BFMS in terms of procedure time, with comparable adverse events, success, and costs.

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Endoscopic Retrieval Technique of Proximally Migrated Pancreatic Stents: A Retrospective Study in a Tertiary Centre

Gastroenterology Research and Practice ◽

10.1155/2015/485980 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Yi Lu ◽

Zheng Jin ◽

Jia-chuan Wu ◽

Li-ke Bie ◽

Biao Gong

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Pancreatic Duct ◽

Clinical Information ◽

Stent Migration ◽

Point Of View ◽

Pancreatic Stent ◽

Success Rates ◽

Tertiary Centre ◽

Endoscopic Retrieval

Background. There were scarce trials concerning the treatments and outcomes of proximal pancreatic stent migration. Herein, we did a retrospective study to discuss this problem from an endoscopist’s point of view.Patients and Methods. From January 2009 to June 2014, patients with proximally migrated pancreatic duct stents were identified. Their clinical information was viewed. Retrieval techniques, success rates, and adverse events were analyzed.Results. A total of 36 procedures were performed in 34 patients; the median age of the patients was 53 years, with 17 males and 17 females. Eight patients’ pancreatic duct stents could still be seen in the major or minor papilla and were pulled out with a snare forceps or a grasping forceps; in the remaining 28 procedures, the management was somewhat thorny; the retrieval called for several devices. Final success was achieved in 31 patients. No adverse event was observed in the process of ERCP procedures, 5 patients developed post-ERCP pancreatitis (PEP), 1 patient got infection, and 1 patient had haemorrhage.Conclusions. Endoscopic retrieval of migrated pancreatic stent is safe and less invasive; nonetheless, attention should be paid so as to reduce the incidence and degree of related adverse events, especially PEP.

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Retreival of a migrated and incorporated lumen apposing metal stent from pancreatic body using laparoscopic technique alone

International Surgery Journal ◽

10.18203/2349-2902.isj20194455 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3849

Author(s):

Hetish M. Reddy ◽

Rajendra Bagree ◽

Subhanshu Gaurav ◽

Syed Gazanfar Imam ◽

Pradeep Panwar

Keyword(s):

Pancreatic Head ◽

Laparoscopic Approach ◽

Stent Migration ◽

Laparoscopic Technique ◽

Metal Stents ◽

Metal Stent ◽

Pancreatic Fluid ◽

Endoscopic Retrieval ◽

Endoscopic Assistance ◽

Fluid Collections

Endoscopic or endoscopic ultrasound-guided drainage (EUS-GD) has become the mainstay of treatment for symptomatic pancreatic fluid collections. Various plastic or metal stents are available to facilitate drainage, amongst which lumen apposing metal stent (LAMS) has better efficacy and fewer complications in comparison with others. Though most drainage related complications can be managed non-operatively, stent related complications like stent migration may sometimes require a surgical retrieval. The longer the observation period, the harder the retrieval in rare cases wherein the LAMS migrates and incorporates in the retroperitoneum. When endoscopic retrieval is not an option, laparoscopic approach might be considered as an alternative to open surgery. We report a case of successful laparoscopic retrieval of a LAMS, 5 months after its migration and getting incorporated in the pancreatic head, without endoscopic assistance.

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