A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

Lee, Hyun Jik; Chung, Moon Jae; Park, Jeong Yup; Park, Seung Woo; Nam, Chung Mo; Song, Si Young; Bang, Seungmin

doi:10.1007/s00464-016-5341-8

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…The incidence of stent dysfunction for patients with MBO was reported in 15 - 31% following placement of uncovered metal stents [ 8 19 ] and this is largely due to tumor ingrowth through the mesh. [ 20 21 ] Given that tissue ingrowth was the major cause of stent dysfunction and clogging only modestly contributes to stent dysfunction,[ 19 22 23 ] stent insertion location did not affect stent patency. Metal stent placement across the SO did not increase stent occlusion or shorten patency time compared with metal stent placement above the SO.…”

Section: Discussionmentioning

confidence: 99%

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Zhang

Liu

et al. 2018

Saudi J Gastroenterol

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Background/Aims:Metal stent insertion is a common palliative treatment for distal malignant biliary obstruction (MBO) but whether placement across the sphincter of Oddi (SO) causes more complications or shorter survival is in question. The aim of this study was to compare the clinical outcomes of percutaneous uncovered self-expandable metal stent placement above and across the SO in patients with distal MBO.Patients and Methods:We retrospectively studied 59 patients who underwent uncovered metal stent placement for distal MBO between January 2012 and March 2016. Stents were placed above the SO for 22 subjects (group A) and across the SO for 37 subjects (group B). Early cholangitis, stent occlusion, and overall survival time were compared between the two groups.Results:Clinical success was 90.9 and 86.5% for groups A and B, respectively. Early cholangitis occurred in 2 patients (9.1%) in group A and in 6 patients (16.2%) in group B (P = 0.645). Median stent patency and median survival time was 105 and 140 days for group A, 120 and 160 days for group B, respectively. The stent occlusion (31.8% in group A and 21.6% in group B, P = 0.454) and the cumulative stent patency times (P = 0.886) did not differ between the two groups. There was no significant difference in cumulative patient survival between the two groups (P = 0.810).Conclusion:Uncovered metal stent placement across the SO did not significantly affect early cholangitis, stent patency, or patient survival.

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Section: Discussionmentioning

confidence: 99%

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Zhang

Liu

et al. 2018

Saudi J Gastroenterol

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“…The DBS was invented with the objective of reducing ingrowth, while preserving the advantages of uncovered stents. Lee et al 5 compared the DBS and conventional uncovered SEMS and reported that tumor ingrowth was less frequent and stent patency was longer with the DBS, indicating that it is a promising option, at least when choosing uncovered SEMSs.…”

Section: Discussionmentioning

confidence: 99%

“…In the current scenario, the prevalence of recurrent biliary obstruction (RBO) is relatively high, irrespective of the type of stent used, owing to the advancement in antitumor therapy. Recently, a uniquely structured SEMS, which is constructed by the cross-overlapping of two uncovered SEMS called the “double bare stent (DBS),” has been developed with the aim to extend the patency period even further 5 . This unique SEMS is expected to reduce ingrowth, which is a major cause of uncovered SEMS occlusion, by reducing the size of the stent cells.…”

Section: Introductionmentioning

confidence: 99%

Double bare metal stent deployment combined with intraductal radiofrequency ablation for malignant distal biliary obstruction: a prospective pilot study

Inoue

Ibusuki

Kitano

et al. 2023

Sci Rep

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Although uncovered self-expandable metal stents (SEMSs) possess certain advantages such as averting cystic duct obstruction and stent migration, they are susceptible to ingrowth occlusion. The combination of the double bare stent (DBS) and endobiliary radiofrequency ablation (RFA) may reduce ingrowth. Hence, this study aimed to examine the utility of this method for the treatment of unresectable malignant distal biliary obstruction (MDBO). This prospective, single-center, pilot study enrolled 51 patients who met the eligibility criteria between February 2020 and January 2022. The study outcomes included technical success, clinical success, recurrent biliary obstruction (RBO), and other adverse events (AE) besides RBO associated with DBS placement with RFA for MDBO. The technical success rate was 98.0% (50/51). Clinical success was achieved in all patients in whom technical success was achieved. The rates of early and late AEs were 5.9% (3/51) and 8.0% (4/50), respectively. The incidence rate of RBO was 38.0% (19/50). Sludge occlusion, ingrowth occlusion, and overgrowth occlusion occurred in 26.0% (13/50), 8.0% (4/50), and 2.0% (1/50) of patients, respectively (the main cause of RBO was undeterminable in 1 patient). The median time to RBO was 241 days. DBS with RFA showed good technical feasibility, good long-term outcomes, acceptable AE rates, and most importantly, a low ingrowth occlusion rate when employed for the treatment of MDBO.

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“…Although the placement of bare-metal stents has an obvious therapeutic effect for malignant biliary obstruction, potential complications, such as stent restenosis, attract much clinical attention. [ 12 , 13 ] Because lesions may be involved in obstruction of the ampulla of Vater, the placement of stents may influence the structure or function of Vater's ampulla, and increase the incidence rates of complications in patients with lower bile duct obstruction. [ 14 – 16 ] In addition, several studies have reported that stents across the ampulla could lead to stent restenosis and cholangitis because of the intestinal-biliary backflow, thereby reducing the curative effect.…”

Section: Introductionmentioning

confidence: 99%

Bare-metal stents across the Vater's ampulla is a safe method for patients with lower bile duct obstruction

Mao

Wen

et al. 2017

Medicine

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This study explored the effect of the implant position of stents across the Vater's ampulla on treatment outcomes in patients with lower bile duct obstruction.In the retrospective study, 41 patients with malignant obstruction of the lower bile duct and obstructive jaundice received percutaneous transhepatic biliary placement of bare-metal stents. Basic demographic data on patients, such as sex, age, and primary diseases, and follow-up data, including postoperative complications and jaundice-free survival, were recorded. The follow-up data on patients with an involved ampulla, patients with an uninvolved ampulla, patients with a stent across the ampulla, and patients with a stent at a site other than the ampulla were compared. Furthermore, prognostic factors for jaundice- free survival were investigated using Cox proportional hazards regression analysis.Among the 41 patients, 38 patients experienced subsiding of jaundice, whereas 3 cases had unsuccessful stent patency. Whether or not the ampulla was involved did not influence the incidence rates of postoperative complications and the jaundice-free survival time. Notably, when stents were placed across the ampulla, the jaundice-free survival time was significantly longer than when stents were placed at sites other than across the ampulla (P < .05). Furthermore, placement of the stent across the ampulla or at other sites was an independent prognostic factor (hazard ratio = 0.154, 95% confidence interval 0.042–0.560, P = .005) for jaundice-free survival of patients.The current study revealed that the implant position of a stent across the ampulla resulted in maintenance of stent patency and prolongation of the jaundice-free survival time.

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A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

Cited by 8 publications

References 27 publications

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Double bare metal stent deployment combined with intraductal radiofrequency ablation for malignant distal biliary obstruction: a prospective pilot study

Bare-metal stents across the Vater's ampulla is a safe method for patients with lower bile duct obstruction

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