A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

Choi, Jae Myoung; Kim, Jin Hong; Kim, Soon Sun; Yu, Jun; Hwang, Jae Chul; Yoo, Byung Moo; Park, Sang Heum; Kim, Ho Gak; Lee, Dong Ki; Ko, Kang Hyun; Yoo, Kyo Sang; Park, Do Hyun

doi:10.5946/ce.2012.45.1.78

Cited by 10 publications

(5 citation statements)

References 32 publications

(39 reference statements)

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“…Jaundice and liver dysfunction without IHBD dilatation in HCC patients are thought to indicate liver failure, which is difficult to improve via biliary drainage; this may explain why our findings were superior to those of previous studies. However, the clinical success rates of EBD in other malignant strictures, such as hilar cholangiocarcinoma, have been reported to range from 54% to 91.3% [16][17][18][19]. Our data are not inferior to those of previous reports on other malignant strictures, either.…”

Section: Discussioncontrasting

confidence: 61%

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

et al. 2021

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Background Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction. Methods This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated. Results A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child–Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47–10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87–5.37). HCC Stage I/II/III (HR 0.57, CI 0.34–0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32–0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21–0.70, p = 0.0018) were significant factors associated with a long survival. Conclusions EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis. Trial registration Retrospectively registered.

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Section: Discussioncontrasting

confidence: 61%

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

et al. 2021

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“…Our results regarding postoperative survival time were very promising and were consistent with the 6- to 9-month median survival time reported in previous studies. [ 18 – 20 ] Therefore, we conclude that biliary stent reimplantation improves the quality of life and increases survival time in patients with recurrent MOJ. Moreover, PTCD does not require complex equipment and patients are free from the high risk of surgery and general anesthesia.…”

Section: Discussionmentioning

confidence: 77%

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents

et al. 2017

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We aimed to assess the therapeutic effect of reimplantation of biliary metal stents by percutaneous transhepatic cholangial drainage (PTCD) in patients with recurrent malignant obstructive jaundice (MOJ). Furthermore, we explored the prognostic value of inflammation-based markers in these patients.We reviewed 33 cases of recurrent MOJ after implantation of biliary metal stents by PTCD, all of which underwent reimplantation of stents under digital subtraction angiography guidance. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were compared between before and after reimplantation (1 week, 1 month, and 3 months postoperatively). Preoperative clinical data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (SII, neutrophil × platelets/ lymphocyte), platelets-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was overall survival (OS), which was estimated by the Kaplan–Meier method and Cox regression analysis.The levels of ALT, AST, total bilirubin, and direct bilirubin significantly reduced after the reimplantation operation. During a median follow-up time of 10 months, 18 (54.5%) patients died. Gender, albumin, SII, PLR, NLR, and MLR were found to be associated with OS by the log-rank test and univariate analysis. Multivariate Cox analysis identified elevated levels of SII and PLR as significant factors for predicting poor OS.Reimplantation is clinically feasible in patients with recurrent MOJ after implantation of biliary metal stents. SII and PLR are independent, useful inflammation-based prognostic models for predicting outcomes in these patients.

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“…). To date, several randomized control trials have been done comparing PS with SEMS for palliation of malignant distal biliary obstruction and these are shown in Table . Although the technical placement success rates for both stents were similar, the occlusion rate of plastic stents is higher than that of SEMS.…”

Section: Distal Bile Duct Stricturesmentioning

confidence: 99%

Current status and issues regarding biliary stenting in unresectable biliary obstruction

Itoi

Itokawa

Tonozuka

et al. 2013

Digestive Endoscopy

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In the present review, we describe the current status of biliary stenting in patients with unresectable malignant biliary strictures. Self-expandable metallic stents (SEMS) are the ideal biliary stent for both distal and hilar biliary strictures, although in terms of distal biliary strictures, there is still some debate as to the selection of covered or uncovered SEMS, suprapapillary or transpapillary stent placement, side-by-side or stent-in-stent placement, unilateral or bilateral stent placement and the necessity for sphincterotomy. Further high-quality randomized controlled trials for these procedures are warranted.

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A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

Cited by 10 publications

References 32 publications

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents

Current status and issues regarding biliary stenting in unresectable biliary obstruction

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