A retrospective study assessing fully covered metal stents as first-line management for malignant biliary strictures

Sampaziotis, Fotios; Elias, J. Dominguez; Gelson, William; Gimson, Alexander; Griffiths, William J.; Woodward, Jeremy; Shariff, Mohamed; Macfarlane, B; King, Alistair; Corbett, Gareth; Leahy, Anthony

doi:10.1097/meg.0000000000000455

Cited by 13 publications

(14 citation statements)

References 29 publications

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“…There was no significant difference in complication rate among the three groups. Most of comparative studies have shown no difference in complication rates between covered and uncovered SEMSs [ 8 , 10 – 13 , 19 – 23 ]. Nakai et al reported some risk factors of stent-related cholecystitis [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

et al. 2017

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BackgroundSelf-expandable metal stents (SEMSs) are widely used for malignant biliary obstructions. Nitinol-covered SEMSs have been developed to improve stent patency. Currently, SEMSs may be uncovered, partially covered, or fully covered; however, there is no consensus on the best stent type for the management of malignant distal biliary obstruction (MDBO).MethodsPatients with unresectable MDBO receiving SEMS (Wallflex™) were retrospectively analyzed. Time to recurrent biliary obstruction (TRBO) and survival time were compared among the three types of SEMSs. Univariate and multivariate analyses were performed to identify risk factors for stent dysfunction.ResultsIn total, 101 patients received SEMSs for unresectable MDBO (44 uncovered, 28 partially covered, and 29 fully covered SEMSs). Median survival time was 200, 168, and 276 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. There were no differences in survival among the three groups. Median TRBO was 199, 444, and 194 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. Partially covered SEMSs had longer TRBO than uncovered (p = 0.013) and fully covered (p = 0.010) SEMSs. Tumor ingrowth occurred only with uncovered SEMSs and stent migration occurred only with fully covered SEMSs. Multivariate analyses confirmed that partially covered SEMSs have lower risk of dysfunction.ConclusionsPartially covered SEMSs with a proximal uncovered flared end have longer patency than uncovered and fully covered SEMSs by preventing tumor ingrowth and stent migration.

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Section: Discussionmentioning

confidence: 99%

“…Some of these studies demonstrated the superiority of covered SEMSs to uncovered SEMSs, whereas others did not. Similarly, two meta-analyses of these studies and retrospective cohort studies have different conclusions [ 17 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

et al. 2017

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“…While some studies have found that covered stents have longer patency in distal MBO patients than uncovered stents [6,9], these covered stents do not slow the cancer progression. Covered stent insertion has also been related to higher rates of cholecystitis and pancreatitis in treated patients [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Distal malignant biliary obstruction (MBO) is usually caused by primary biliary and pancreatic tumours [1][2][3][4][5]. Between 42% and 77% of patients with distal MBO suffer from pancreatic carcinoma (PC) [4,6,7]. PC itself is a highly malignant tumour; moreover, when it is the cause of distal MBO, surgical resection is only possible in a minority (10-20%) of cases, and even then the 3-and 5-year survival rates of these patients are just 18-52% and 5-31%, respectively [8].…”

Section: Introductionmentioning

confidence: 99%

Stenting with high-intensity focused ultrasound ablation for distal biliary obstruction caused by pancreatic carcinoma: a meta-analysis

Liu¹,

Cui²,

Kan³

et al. 2022

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Introduction: Between 42% and 77% of patients with distal malignant biliary obstruction (MBO) suffer from pancreatic carcinoma (PC).Aim: To analyse the clinical efficacy of stenting accompanied by high-intensity focused ultrasound (HIFU) ablation in patients with distal MBO from PC.Material and methods: Relevant articles published through March 2021 were identified in the Pubmed, Cochrane Library, Embase, Wanfang, VIP, and CNKI databases. RevMan v5.3 and Stata v12.0 were used for the meta-analysis.Results: Twenty-nine articles were initially identified, and 5 of these were eventually included. These articles described 142 patients who underwent biliary stenting alone and 132 patients who underwent biliary stenting with HIFU ablation. The pooled Δ total bilirubin (TBIL) values were comparable between the 2 treatment groups (p = 0.10). The pooled stent dysfunction rate was significantly greater in the group with stenting alone (p = 0.03), and the pooled HR for the stent patency duration indicated that the duration of stent patency was increased in the stenting with HIFU ablation group (p < 0.0001). Overall survival rates were significantly longer in the stenting with HIFU ablation group (p < 0.0001). HIFU ablation was associated with an 80% pooled clinical response rate. The pooled cholangitis (p = 0.47) and pancreatitis (p = 0.56) rates were comparable between the 2 groups. Funnel plots did not reveal any significant evidence of endpoint-associated publication bias.Conclusions: Stenting with HIFU ablation increased both stent patency and overall survival in patients with distal MBO caused by PC compared to stenting alone.

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“…Fully covered self-expanding metal stents (FCSEMSs) have been recognized as an optimal therapy for benign biliary strictures and palliative management of malignant biliary obstructions 1 8 9 10 . However, the long-term unobstructed rate of FCSEMSs in clinical usage remains limited.…”

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confidence: 99%

A novel biliary stent coated with silver nanoparticles prolongs the unobstructed period and survival via anti-bacterial activity

Yang

Ren

Chai

et al. 2016

Sci Rep

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Symptomatic biliary stricture causes life-threatening complications, such as jaundice, recurrent cholangitis and secondary biliary cirrhosis. Fully covered self-expanding metal stents (FCSEMSs) are gaining acceptance for treatments of benign biliary stricture and palliative management of malignant biliary obstructions. However, the high rate of FCSEMS obstruction limits their clinic use. In this study, we developed a novel biliary stent coated with silver nanoparticles (AgNPs) and investigated its efficacy both in vitro and in vivo. We first identified properties of the AgNP complex using ultraviolet detection. The AgNP complex was stable without AgNP agglomeration, and Ag abundance was correspondingly increased with an increased bilayer number. The AgNP biliary stent demonstrated good performance in the spin-assembly method based on topographic observation. The AgNP biliary stent also exhibited a long-term anti-coagulation effect and a slow process of Ag+ release. In vitro anti-bacteria experiments indicated that the AgNP biliary stent exhibited high-efficiency anti-bacterial activity for both short- and long-term periods. Importantly, application of the AgNP biliary stent significantly prolonged the unobstructed period of the biliary system and improved survival in preclinical studies as a result of its anti-microbial activity and decreased granular tissue formation on the surface of the anastomotic biliary, providing a novel and effective treatment strategy for symptomatic biliary strictures.

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A retrospective study assessing fully covered metal stents as first-line management for malignant biliary strictures

Abstract: The use of FCSEMS as first-line management for DMBS is associated with longer patency and reduced complication rates compared with the use of PS. However, the higher rate of pancreatitis compared with USEMS requires further evaluation in a large randomized controlled trial.

Cited by 13 publications

References 29 publications

Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

Stenting with high-intensity focused ultrasound ablation for distal biliary obstruction caused by pancreatic carcinoma: a meta-analysis

A novel biliary stent coated with silver nanoparticles prolongs the unobstructed period and survival via anti-bacterial activity

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