Antireflux stents to reduce the risk of cholangitis in patients with malignant biliary strictures: a randomized trial

Hu, Bing; Wang, Tiantian; Wu, Jun; Shi, Zhang; Gao, Dao‐jian; Pan, Ya-min

doi:10.1055/s-0034-1364872

Cited by 66 publications

(92 citation statements)

References 7 publications

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“…There were no differences in jaundice resolution (87.5 and 84%, respectively), but median stent patency of the ARMS group was significantly increased by 3 months (13 ± 3.4 vs 10 ± 1.2 months, p < 0.05). Moreover, cholangitis episodes decreased with the implantation of partially covered ARMS compared with U-SEMS (10 vs 21 episodes, respectively, p < 0.05) [73].…”

Section: Antireflux Metal Stentsmentioning

confidence: 91%

Novel biliary self-expanding metal stents: indications and applications

Bléro

Huberty

Devière

2014

Expert Review of Gastroenterology & Hepatology

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Endoscopic insertion of a self-expanding metal stent (SEMS) through a malignant common bile duct stricture is the first line of palliation for malignant jaundice. Patency of these stents remains a major concern. SEMS dysfunction can result from tumor ingrowth, overgrowth and/or clogging. Initial SEMS modifications involved covering the central part of the stent in order to reduce ingrowth and ultimately increase patency. Fully covered stents became available shortly after reports of their use in human patients. The potential removability and radial strength of SEMS have led to evaluation of their use in new indications including benign biliary strictures, post sphincterotomy bleeding and perforation. Other aspects of development include the addition of features such as anti-reflux valves, drug elution and spontaneous biodegradability. These aspects and their clinical implications are reviewed and discussed.

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Section: Antireflux Metal Stentsmentioning

confidence: 91%

Novel biliary self-expanding metal stents: indications and applications

Bléro

Huberty

Devière

2014

Expert Review of Gastroenterology & Hepatology

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“…In a landmark randomized trial by Hu et al . (n=112),16 an ARMS with a nipple-shaped valve was associated with a significantly longer patency time compared with a conventional uncovered SEMS (13 months vs 10 months, p=0.04) as well as a lower rate of cholangitis. In a more recent randomized trial by Lee et al .…”

Section: Discussionmentioning

confidence: 95%

“…To mitigate the risk of SEMS dysfunction due to the duodenobiliary reflux, ARMS with various types of antireflux valves were developed (Table 3),13–16 and showed potential effectiveness in terms of the prolongation of SEMS patency time and the reduction of the frequency of cholangitis during the follow-up period. In a landmark randomized trial by Hu et al .…”

Section: Discussionmentioning

confidence: 99%

“…To overcome the problems associated with duodenobiliary reflux, an antireflux metal stent (ARMS) with a valve to prevent the reflux at the distal end was developed, and several investigators have reported the effectiveness of ARMS for nonresectable distal malignant biliary obstruction 13–16. While the designs of antireflux valves in those studies were different, ARMS have been reported to successfully provide longer patency time with a lower rate of cholangitis, compared with conventional SEMS.…”

Section: Introductionmentioning

confidence: 99%

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Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study

et al. 2017

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Background/AimsIn distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent.MethodsPatients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement.ResultsIn total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced non-occlusion cholangitis.ConclusionsThe ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted.

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“…5). 24,25 Drug-eluting covering membranes (which allow the controlled release of anti-cancer drugs such as OK-432 26 and paclitaxel 27,28 ) and special wire-braided, double-layered structures have been developed 29,30 to inhibit tumor ingrowth (Fig. 6).…”

Section: Specific and Dedicated Structure Of Semsmentioning

confidence: 99%

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent

Yang¹,

Moon²,

You³

et al. 2016

Korean J Pancreas Biliary Tract

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Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque markers, are discussed in this review. What we know about the physical and mechanical properties of the SEMS is very important. With an understanding of the basic knowledge of metal stents, hurdles such as stent occlusion, migration, and kinking can be overcome to develop more ideal SEMS.

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Antireflux stents to reduce the risk of cholangitis in patients with malignant biliary strictures: a randomized trial

Abstract: Stenting with pcARMS compared with standard ucSEMS reduces risk of ascending cholangitis and has longer stent patency, but does not increase patient survival. Chictr.org. number, ChiCTR-TRC-11001800.

Cited by 66 publications

References 7 publications

Novel biliary self-expanding metal stents: indications and applications

Novel biliary self-expanding metal stents: indications and applications

Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent

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