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

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.

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

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.

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

2009 ◽  
Vol 50 (7) ◽  
pp. 730-737 ◽  
Author(s):  
I. C. Rasmussen ◽  
U. Dahlstrand ◽  
G. Sandblom ◽  
L. G. Eriksson ◽  
R. Nyman
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Biliary Duct ◽  
Stent Insertion ◽  
Stent Fracture ◽  
Metallic Stent ◽  
Stent Patency ◽  
Life Threatening ◽  
The Mean

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.

Malignant biliary obstruction: treatment with self-expandable metallic stents

1995 ◽  
Vol 5 (1) ◽  
Author(s):  
T. Cumhur ◽  
M.N. �smen ◽  
O. Akhan ◽  
T. �l�er ◽  
S. �ekirge ◽  
...  
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Expandable Metallic Stents

scholarly journals Covered Stents versus Uncovered Stents for Unresectable Malignant Biliary Strictures: A Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ming-Yu Chen ◽  
Jia-Wei Lin ◽  
He-Pan Zhu ◽  
Bin Zhang ◽  
Guang-Yi Jiang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Patient Survival ◽  
Meta Analysis ◽  
Covered Stents ◽  
Random Effects Model ◽  
Biliary Strictures ◽  
Stent Patency ◽  
Sems Group ◽  
Uncovered Stents ◽  
Significant Difference

Aim. To summarize the covered or uncovered SEMS for treatment of unresectable malignant distal biliary obstruction, comparing the stent patency, patient survival, and incidence of adverse events between the two SEMSs.Methods. The meta-analysis search was performed independently by two of the authors, using MEDLINE, EMBASE, OVID, and Cochrane databases on all studies between 2010 and 2015. Pooled effect was calculated using either the fixed or the random effects model.Results. Statistics shows that there is no difference between SEMSs in the hazard ratio for patient survival (HR 1.04; 95% CI, 0.92–1.17;P=0.55) and stent patency (HR 0.87, 95% CI: 0.58 to 1.30,P=0.5). However, incidence of adverse events (OR: 0.74, 95% CI: 0.57 to 0.97,P=0.03) showed significant different results in the covered SEMS, with dysfunctions events (OR: 0.75, 95% CI: 0.56 to 1.00,P=0.05) playing a more important role than complications (OR: 0.87, 95% CI: 0.58 to 1.30,P=0.50).Conclusions. Covered SEMS group had lower incidence of adverse events. There is no significant difference in dysfunctions, but covered SEMS trends to be better, with no difference in stent patency, patient survival, and complications.

Self-Expandable Metallic Stents for Malignant Biliary Obstruction with Anomalous Pancreaticobiliary Junction

2007 ◽  
Vol 65 (5) ◽  
pp. AB234
Author(s):  
Hirofumi Kogure ◽  
Hiroyuki Isayama ◽  
Hiroshi Yagioka ◽  
Takashi Sasaki ◽  
Yousuke Nakai ◽  
...  
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
Metallic Stents ◽  
Anomalous Pancreaticobiliary Junction ◽  
Expandable Metallic Stents
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