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

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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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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Tu1683 Management of Occluded Self-Expandable Metallic Stents in Patients With Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.03.1329 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB487-AB488

Author(s):

Tilak Shah ◽

Svetang V. Desai ◽

Mahfuzul Haque ◽

Hassan K. Dakik ◽

Deborah A. Fisher

Keyword(s):

Systematic Review ◽

Biliary Obstruction ◽

Meta Analysis ◽

Malignant Biliary Obstruction ◽

Metallic Stents ◽

Expandable Metallic Stents

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A new 12-French plastic stent for unresectable distal malignant biliary obstruction

Endoscopy ◽

10.1055/a-1120-8498 ◽

2020 ◽

Vol 52 (06) ◽

pp. 474-482

Author(s):

Pierre H. Deprez ◽

Tom G. Moreels ◽

Tarik Aouattah ◽

Hubert Piessevaux ◽

Enrique Pérez-Cuadrado-Robles

Keyword(s):

Adverse Events ◽

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Plastic Stents ◽

Metal Stents ◽

Technical Success ◽

Stent Patency ◽

Historical Cohort ◽

Plastic Stent ◽

Distal Malignant Biliary Obstruction

Background Self-expanding metal stents (SEMSs) are recommended in unresectable distal malignant biliary obstruction. However, problems with dysfunction and migration of these stents are not negligible. We aimed to investigate the effectiveness and safety of a new 12-Fr plastic stent. Methods In an observational, prospective study, all consecutive patients who underwent biliary stenting with the 12-Fr stent were considered (index group). Referent groups were a historical cohort, matched by sex, etiology, and metastatic status, including patients with 10-Fr plastic stents and with fully covered and uncovered SEMSs (FCSEMSs and UCSEMSs). Outcomes were stent patency, recurrent biliary obstruction (RBO), technical success, 30-day mortality and adverse events. A post-procedure examination of removed stents was done. Results 72 patients (median age 66, range 32 – 94 years, 50 % men) were included (24 index, 48 referents). There were no differences in median stent patency time (P = 0.684). RBO was significantly lower with the 12-Fr compared with the 10-Fr profile stent (50 % vs. 81.3 %, P = 0.04), but no difference was found compared with the FCSEMSs (50 % vs. 43.8 %, P = 0.698). Technical success was 100 %, with no differences in 30-day mortality P = 0.105). The adverse events rate was 4.2 % for both groups (index n = 1, referents n = 2). Of 11 removed 12-Fr plastic stents suspected to be dysfunctional, 7 (64 %) were still patent. Conclusions This new 12-Fr plastic stent could be an effective and cheaper alternative to SEMSs in distal malignant biliary obstruction.

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Efficacy of the New Double-Layer Stent for Unresectable Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2012/680963 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Ken Ito ◽

Yoshinori Igarashi ◽

Takahiko Mimura ◽

Yui Kishimoto ◽

Yoshinori Kikuchi ◽

...

Keyword(s):

Life Expectancy ◽

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Plastic Stents ◽

Metal Stents ◽

Short Life ◽

First Choice ◽

Significant Difference ◽

Distal Malignant Biliary Obstruction ◽

Short Life Expectancy

Background and Aims. For distal malignant biliary obstruction in cases with short life expectancy, occlusion of plastic stents (PSs) does not usually occur before death, and the application of such a procedure is considered adequate from the viewpoint of cost-effectiveness. Methods and Setting. A new commercially available DLS with side holes, a conventional DLS, and, uncovered self-expanding metal stents (SEMSs) were retrospectively evaluated in patients with jaundice due to unresectable distal malignant biliary obstruction. Results. A total of 64 patients received endoscopic biliary stenting (23 patients with the new DLS, 24 patients with conventional DLS, and 17 patients with uncovered SEMS) from December 2002 to August 2009. Median patency time was found to be 198 days for the new DLS group and 99 days for the conventional DLS group, revealing a significant difference between devices. There was, however, no significant difference in median patency time between the new DLS and the uncovered SEMS (198 days versus 344 days). Conclusion. The new DLS is efficient and safe and may be considered the first choice for unresectable distal malignant obstruction in cases with short life expectancy.

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

Acta Radiologica ◽

10.1080/02841850903039763 ◽

2009 ◽

Vol 50 (7) ◽

pp. 730-737 ◽

Cited By ~ 13

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.

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