Expandable metallic biliary endoprostheses: preliminary clinical evaluation.

Abstract

A biliary endoprosthesis constructed of self-expanding metallic "Z" stents was placed in 23 patients with obstructive jaundice. The biliary obstruction was due to a malignant neoplasm in 21 patients and a postoperative biliary stricture in two patients. The lesions affected the intrahepatic biliary ducts in 13 patients. Twelve patients had undergone radiation therapy before stent placement. The endoprostheses consisted of 196 expandable metallic biliary stents placed singly (n = 10) or in tandem (n = 186). As many as 18 stents were used to relieve an obstruction in one patient. A transhepatic approach was employed in all patients except one in whom stents were placed through a T-tube tract. Within 1 week after placement, all stents expanded to at least 90% of their original diameter. Three misplaced, two deformed, and two dislodged stents caused no obvious clinical problems. At follow-up, which ranged from 2 to 59 weeks, five patients experienced recurrent jaundice. Two patients with recurrent jaundice due to obstruction of the bile duct containing the stent were treated with external catheter drainage. The expandable biliary endoprosthesis is suggested as an effective treatment for benign and malignant biliary obstruction.

Long-Term Palliative Treatment of Hepatocellular Carcinoma Extending into the Portal Vein and Bile Duct by Chemoembolization and Metallic Stenting

“…Self-expanding metallic stents have been widely used to treat malignant biliary strictures [4][5][6][7][8], but tumor ingrowth into the stent lumen causes restenosis or obstruction, especially in malignant stenoses caused by the presence of intraductal tumor [4][5][6][7][8]. Stents covered with some membrane to prevent tumor ingrowth into the stent lumen have been studied both experimentally and clinically [9][10][11].…”

Pancreatic Cancer: Stenting versus Surgery

“…All types have been first deployed through the percutaneous transhepatic route [27][28][29][30][31][32] and some have not yet become available in an endoscopically usable form.…”

“…It requires balloon expansion at the time of place ment. there are technical failures in up to 18% and there is no subsequent self-expansion in its original form [26,27,36]. One randomized trial [27] included these devices but used the endoscopic version in common bile duct lesions and the transhepatic version for hilar lesions compared with plastic stents inserted by the same routes.…”

“…there are technical failures in up to 18% and there is no subsequent self-expansion in its original form [26,27,36]. One randomized trial [27] included these devices but used the endoscopic version in common bile duct lesions and the transhepatic version for hilar lesions compared with plastic stents inserted by the same routes. Unfortu nately, all metallic stents (Strecker and Wallstent patients) were reported together suggesting an overall improvement in palliation with less time in hospital, a lower incidence of early cholangitis and a lower late occlusion rate.…”

“…4) of 42-68 mm length [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Initial open studies were con ducted in Europe [28,29-31.43] in a total of 293 patients with malignant biliary obstruction.…”