Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

Pu, Leonardo Zorrón Cheng Tao; Moura, Eduardo Guimarães Hourneaux de; Bernardo, Wanderley Marques; Baracat, Felipe Iankelevich; Mendonça, Ernesto Quaresma; Kondo, André; Luz, Gustavo O.; Júnior, Carlos Kiyoshi Furuya; Artifon, Everson Luiz de Almeida

doi:10.3748/wjg.v21.i47.13374

“…Endoscopic SEMS' placement is currently regarded as the standard palliative treatment for patients with unresectable, malignant distal CBD obstruction. SEMS have a larger luminal diameter and guarantee longer patency than plastic stents, but their benefits in terms of survival have not been established despite several meta-analyses on the subject [1,28,29]. Nevertheless, longer stent patency may be important to maintain quality of life during the survival period post SEMS' placement for patients with malignant distal CBD obstruction and to reduce the need for reintervention or the potential for cholangitis since the expected patient life span is increasing due to the development of palliative treatments, including chemotherapy, immunotherapy, and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): study protocol for a multicenter randomized controlled trial

Choi

¹

,

Paik

²

,

You

³

et al. 2020

Trials

2

0

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Background: Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around 8 months, it has recently been reported that the duration of SEMS' patency in patients using aspirin is prolonged. Our study, therefore, aims to investigate the effect of aspirin on SEMS' patency.Methods/design: This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebocontrolled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (aged ≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for 6 months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion:The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study should determine the efficacy of aspirin in maintaining metal-stent patency in patients with malignant distal CBD obstructive.

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“…SEMS have a larger luminal diameter and guarantee longer patency than plastic stents, but their benefits in terms of survival have not been established despite several meta-analyses on the subject. [1,28,29] Nevertheless, longer stent patency may be important to maintain quality of life during the survival period post-SEMS placement for patients with malignant distal CBD obstruction and to reduce the need for reintervention or the potential for cholangitis since the expected patient life span is increasing due to the development of palliative treatments, including chemotherapy, immunotherapy, and radiotherapy. Recently, the impact of biliary stent-related adverse events during palliative chemotherapy has been emphasized from the perspective of patient morbidity.…”

Section: Discussionmentioning

confidence: 99%

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): Study protocol for a multicenter randomized controlled trial

Choi

¹

,

Paik

²

,

You

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around eight months, it has recently been reported that the duration of SEMS patency in patients using aspirin is prolonged. Our study therefore aims to confirm the effect of aspirin on SEMS patency. Methods This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebo-controlled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for six months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study will determine the efficacy of aspirin in maintaining metal stent patency in patients with malignant distal CBD obstructive.

show abstract

“…SEMS have a larger luminal diameter and guarantee longer patency than plastic stents, but their benefits in terms of survival have not been established despite several meta-analyses on the subject. [1,25,26] Nevertheless, longer stent patency may be important to maintain quality of life during the survival period post-SEMS placement for patients with malignant distal CBD obstruction and to reduce the need for reintervention or the potential for cholangitis since the expected patient life span is increasing due to the development of palliative treatments, including chemotherapy, immunotherapy, and radiotherapy. Recently, the impact of biliary stent-related adverse events during palliative chemotherapy has been emphasized from the perspective of patient morbidity.…”

Section: Discussionmentioning

confidence: 99%

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): Study protocol for a multicenter randomized controlled trial

Choi

¹

,

Paik

²

,

You

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around eight months, it has recently been reported that the duration of SEMS patency in patients using aspirin is prolonged. Our study therefore aims to confirm the effect of aspirin on SEMS patency. Methods This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebo-controlled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for six months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study will determine the efficacy of aspirin in maintaining metal stent patency in patients with malignant distal CBD obstructive.

show abstract

Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

Abstract: SEMS are associated with lower stent dysfunction, lower re-intervention rates, better survival, and higher patency time. Complications and costs showed no difference.

Cited by 83 publications

References 35 publications

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): study protocol for a multicenter randomized controlled trial

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): study protocol for a multicenter randomized controlled trial

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): Study protocol for a multicenter randomized controlled trial

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): Study protocol for a multicenter randomized controlled trial

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