Predictors of stent dysfunction in patients with bilateral metal stents for malignant hilar obstruction

Introduction For unresectable hilar obstruction, restoring and maintaining biliary ductal patency are crucial for improved survival and quality of life. The endoscopic placement of stents is now a mainstay of its treatment, and bilateral stenting is effective for biliary decompression. This study aimed to determine the clinical outcomes of bilateral metal stent placement using large cell-type stents and the clinical predictors of stent dysfunction in patients with malignant hilar obstruction. Methods We performed a retrospective analysis of patients who underwent bilateral metal stent placement using two large cell-type stents at two academic teaching hospitals between September 2017 and February 2019. The primary outcome was stent dysfunction. Secondary outcomes included predictors related to stent dysfunction and overall survival. Results The study included 87 patients who underwent bilateral metal stent placement for malignant hilar obstruction. Technical success and clinical success were achieved in 80 patients (92.0%) and 83 patients (95.4%), respectively. During the follow-up period (median: 201, range: 18–671 days), stent dysfunction occurred in 42 patients (48.3%), and the median stent patency was 199 days (95% confidence interval [CI]: 181–262). In univariate analysis, age, cholangitis before stent insertion, and subsequent chemotherapy were found to be associated with the cumulative risk of stent dysfunction. In multivariate analysis, cholangitis before stent insertion (hazards ratio [HR]: 2.26, 95% CI: 1.216–4.209, P = 0.010) and subsequent chemotherapy (HR: 0.250, 95% CI: 0.130–0.482, P<0.001) remained as statically significant factors associated with the cumulative risk of stent dysfunction. The median overall survival was 288 days (95% CI: 230–327). Conclusion The bilateral placement of large cell-type stents for malignant hilar obstruction was effective with high technical and clinical success rates and acceptable patency. Cholangitis before stent insertion was associated with shorter patency, and subsequent chemotherapy was associated with longer stent patency.

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Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Acta Radiologica ◽

10.1177/0284185120978512 ◽

2020 ◽

pp. 028418512097851

Author(s):

Gun Ha Kim ◽

Dong Il Gwon ◽

Gi-Young Ko ◽

Jin Hyoung Kim ◽

Jong Woo Kim ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Patient Survival ◽

Large Cell ◽

Internal Drainage ◽

Cell Type ◽

Stent Patency ◽

Tumor Ingrowth ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

Background To overcome the technical difficulty of bilateral stent-in-stent placement, large cell-type biliary stents have been developed. However, most of the studies using large cell-type stents were conducted with endoscopic method. Purpose To evaluate the efficacy and safety of percutaneous stent placement with a stent-in-stent method using large cell-type stents in patients with malignant hilar biliary obstruction. Material and Methods From December 2015 and October 2018, 51 patients with malignant hilar biliary obstruction were retrospectively studied. All of the patients underwent bilateral (n=46) or unilateral (n=5) stenting in a T, Y, or X configuration with a stent-in-stent method using large cell-type stents. Technical success, complications, successful internal drainage, stent patency, and patient survival were analyzed. Results A total of 118 stents were successfully placed in 51 patients (100.0%). Three patients had minor complications with self-limiting hemobilia. Major complications were not observed in any patient. Successful internal drainage was achieved in 45 patients (88.2%). Clinical follow-up information until death or the end of the study was available for 50 of 51 patients. The median patient survival was 285.5 days (95% confidence interval [CI] 197–374). Stent dysfunction occurred in 16 patients (35.6%) due to tumor ingrowth (n=9) or tumor ingrowth combined with biliary sludge (n=7) among the patients who achieved successful internal drainage. Median stent patency was 179 days (95% CI 104–271). Conclusion Percutaneous stent-in-stent placement with large cell-type stents is technically feasible and safe, and can be an effective technique in patients with malignant hilar biliary obstruction.

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Endoscopic bilateral stent-in-stent placement for malignant hilar obstruction using a large cell type stent

Hepatobiliary & Pancreatic Diseases International ◽

10.1016/s1499-3872(16)60107-8 ◽

2016 ◽

Vol 15 (6) ◽

pp. 633-639 ◽

Cited By ~ 6

Author(s):

Jin Myung Park ◽

Sang Hyub Lee ◽

Kwang Hyun Chung ◽

Dong Kee Jang ◽

Ji Kon Ryu ◽

...

Keyword(s):

Stent Placement ◽

Large Cell ◽

Cell Type ◽

Malignant Hilar Obstruction

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Su1623 Endoscopic Bilateral Stent-in-Stent Placement for Malignant Hilar Obstruction Using a Large Cell Type Stent

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.02.367 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB344

Author(s):

Jin Myung Park ◽

Sang Hyub Lee ◽

Kwang Hyun Chung ◽

Jae MIN Lee ◽

Ji Kon Ryu ◽

...

Keyword(s):

Stent Placement ◽

Large Cell ◽

Cell Type ◽

Malignant Hilar Obstruction

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Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique

10.21203/rs.2.24611/v2 ◽

2020 ◽

Author(s):

Wei-zhong Zhou ◽

Sheng Liu ◽

Zheng-Qiang Yang ◽

Yu-Tao Xian ◽

Hong-Dou Xu ◽

...

Keyword(s):

Overall Survival ◽

Biliary Obstruction ◽

Serum Bilirubin Level ◽

Stent Insertion ◽

Technical Success ◽

Stent Deployment ◽

Stent Patency ◽

Hilar Biliary Obstruction ◽

Bilateral Stenting ◽

Malignant Hilar Biliary Obstruction

Abstract Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.

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Clinical outcomes in patients undergoing multiple self-expandable metallic stent placement by stent in stent technique for malignant gastric outlet obstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.88 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 88-88

Author(s):

Jinwon MO ◽

Jie-Hyun Kim ◽

Seung Yong Shin ◽

Da Hyun Jung ◽

Jae Jun Park ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Stent Placement ◽

Clinical Success ◽

Outlet Obstruction ◽

Metallic Stent ◽

Sems Placement ◽

Stent Patency ◽

Malignant Gastric Outlet Obstruction ◽

The Third ◽

Expandable Metallic Stent

88 Background: Self-expandable metallic stent (SEMS) placement is widely used for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO). The aims were to evaluate the efficacy and safety of multiple gastroduodenal stent placement by stent in stent technique and identify predictive factors about stent patency. Methods: We retrospectively analyzed data from 170 patients with GOO receiving SEMS by stent in stent technique from July 2006 to July 2018. Among them, 90 patients had been treated with gastroduodenal SEMS placement for MGOO. Technical and clinical success rates were evaluated. And, clinical outcomes with predictors of stent patency were also analyzed. Results: Among the subjects, 34.4% were treated with secondary SEMS placement, and 9.7% were treated with third SEMS placement because of the previous stent dysfunction. The median stent patency time was 15.7 weeks (range 0-89) in the first SEMS, 10.4 weeks (range 0-44) in the second SEMS, and 11.3 weeks (range 1-29) in the third SEMS. The technical and clinical success rate were 100% and 97.8% in the first SEMS, 100% and 90.3% in the second SEMS, 100% and 100% in the third SEMS. In multivariable analysis, the first SEMS placement of covered type including Comvi stent was correlated with prolonged stent patency (OR 4.549, P = 0.001). And both chemotherapy after the first SEMS placement (OR 8.248, P = 0.006) and chemotherapy after the second SEMS placement (OR 7.467, P = 0.003) were correlated with prolonged stent patency. Serious complications such as gastrointestinal hemorrhage or perforation did not occur in any patient. Conclusions: Secondary and third gastroduodenal SEMS placement by stent in stent technique is a safe and effective treatment for the first stent dysfunction in MGOO. The stent placement of covered type and chemotherapy after stent placement is the predictor of stent patency. Keywords: Malignant gastric outlet obstruction, Self-expandable metallic stent, Stent in stent technique, Stent patency, Predictive factor

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Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique

10.21203/rs.2.24611/v3 ◽

2020 ◽

Author(s):

Wei-zhong Zhou ◽

Sheng Liu ◽

Zheng-Qiang Yang ◽

Yu-Tao Xian ◽

Hong-Dou Xu ◽

...

Keyword(s):

Overall Survival ◽

Biliary Obstruction ◽

Serum Bilirubin Level ◽

Stent Insertion ◽

Technical Success ◽

Stent Deployment ◽

Stent Patency ◽

Hilar Biliary Obstruction ◽

Bilateral Stenting ◽

Malignant Hilar Biliary Obstruction

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Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

Endoscopy International Open ◽

10.1055/a-1236-3217 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1633-E1638

Author(s):

Jerry Yung-Lun Chin ◽

Samir Seleq ◽

Frank Weilert

Keyword(s):

Clinical Success ◽

Clinical Success Rate ◽

Metal Stents ◽

Metal Stent ◽

Endoscopic Retrograde ◽

Stent Patency ◽

Stent Occlusion ◽

Secondary Endpoints ◽

Mean Time

Abstract Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography. Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions. Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78 %). Technical success was achieved in 100 % of cases, with a clinical success rate of 91.7 %. Mean total bilirubin pre-procedure was 202 umol/L (normal < 20 umol/L) and 63.8 umol/L post procedure (P < .001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating > 50 % reduction in bilirubin (mean bilirubin reduction 75 %). AEs occurred in 12 of 60 patients (20 %), all of which were mild. The reintervention rate was 11.7 % (7/60). Stent occlusion occurred in 10 of 60 patients (16.7 %) with a mean time to stent occlusion of 46.2 days (3–133). Stent patency of 83.3 % was observed with a mean follow up of 7.9 months. Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.

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Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction: Effectiveness and Efficacy on 255 Patients with 12-Month's Follow-up

Gastroenterology Research and Practice ◽

10.1155/2012/296347 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Søren Meisner ◽

Ferran González-Huix ◽

Jo G. Vandervoort ◽

Alessandro Repici ◽

Dimitrios Xinopoulos ◽

...

Keyword(s):

Stent Placement ◽

Clinical Success ◽

Colonic Obstruction ◽

Metal Stents ◽

Control Group ◽

Metal Stent ◽

Multicenter Studies ◽

Malignant Colonic Obstruction ◽

Procedural Success

Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery.Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures.Design. Two prospective, one Spanish and one global, multicenter studies.Settings. 39 centers (22 academic, 17 community hospitals) from 13 countries.Patients. A total of 257 patients were enrolled, and 255 patients were treated with a WallFlex uncovered enteral colonic stent. Follow-up was up to 12 months or until death or retreatment.Interventions(s). Self-expanding metal stent placement.Main Outcome Measures. Procedural success, clinical success, and safety.Results. Procedural success was 98.4% (251). Clinical success rates were 87.8% at 30 days, 89.7% at 3 months, 92.8% at 6 months, and 96% at 12 months. Overall perforation rate was 5.1%. Overall migration rate was 5.5%. Overall death rate during follow-up was 48.6% (124), with 67.7% of deaths related to the patient’s colorectal cancer, unrelated in 32.3%. Only 2 deaths were related to the stent or procedure.Limitations. No control group.Conclusions. The primary palliative option for patients with malignant colonic obstruction should be self-expanding metal stent placement due to high rates of technical success and efficacy in symptom palliation and few complications.

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