Percutaneous Palliation of Malignant Obstructive Jaundice with the Wallstent Endoprosthesis: Follow-up and Reintervention in Patients with Hilar and Non-Hilar Obstruction

Becker, Christoph; Glättli, A; Maibach, Rudolf; Baer, H. U.

doi:10.1016/s1051-0443(93)71930-2

Cited by 100 publications

(47 citation statements)

References 16 publications

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“…A RCT comparing unilateral versus bilateral drainage in patients with malignant hilar obstruction found that drainage of one functional hepatic lobe is sufficient to relieve obstruction with no difference in complication and survival rates [258] . It is important to note that stents placed for hilar lesions will require re-intervention in about 30% of patients due to stent occlusion [259,260] . A RCT comparing covered to uncovered stents in patients with unresectable distal biliary malignancies showed that the patency of covered stents was significantly higher than that of uncovered stents [261] .…”

Section: Biliary Endoprosthesis (Stenting)mentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

253

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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Section: Biliary Endoprosthesis (Stenting)mentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

253

190

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“…Distant metastases (mainly in the liver) [19, 72], size of primary tumor [72], laboratory findings [17, 59, 64, 86], pain [59] or a combination of those factors [79]. Some malignancies causing hilar obstruction have [58, 62, 63] or have not [57, 65] been found to be associated with a significantly poorer prognosis. Thus, endoscopic palliation of MDO compared to MHO has [58, 62, 63] or has not [57, 65] been found to significantly prolong survival.…”

Section: Resultsmentioning

confidence: 99%

“…Some malignancies causing hilar obstruction have [58, 62, 63] or have not [57, 65] been found to be associated with a significantly poorer prognosis. Thus, endoscopic palliation of MDO compared to MHO has [58, 62, 63] or has not [57, 65] been found to significantly prolong survival. Similarly, age at diagnosis has [16] or has not [65] been found to predict survival.…”

Section: Resultsmentioning

confidence: 99%

Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Hammarström

2005

Dig Surg

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Background: Endoscopic biliary drainage for malignant obstructive jaundice is a viable palliative alternative, but its role and cost-effectiveness compared to percutaneous drainage or surgical bypass are subject to debate. Aim: To review the evidence in the literature with regard to the settings in which endoscopic drainage favorably compares with and affords palliation and quality of life comparable to percutaneous drainage or surgical bypass in malignant obstructive jaundice patients. Method: Using PubMed, Embase, Current Contents, and Medline, a literature search was performed for papers published from 1979 to April 2004. All retrieved papers comparing endoscopic drainage with percutaneous or surgical drainage, with special reference to the level of obstruction, were rated according to the strength of evidence and carefully analyzed. Results and Conclusions: Palliative drainage affords improved quality of life. The outcome of endoscopic and percutaneous drainage was similar, but data were few and inconsistent. Due to fewer late complications, surgical bypass is an alternative to metal stents (Wallstent™) which remain patent longer than plastic stents (large-bore polyethylene), with an overall median of 180 and 109 days, respectively, in patients who survive longer than about 6 months, which cannot be accurately predicted though. Overall early and late morbidity, stent patency, and survival were similar in patients treated for hilar compared to distal obstruction.

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“…In a in larger patient population, furthermore, the question of whether they are related to the procedure or are due to other factors present in the patient population may be solved. Becker et al (18) and Gilliams et al (19) reported that in patients with hilar obstruction, the period of stent patency was shorter than in patients with non-hilar obstruction, but survival time was similar. However, after placing two stents (in a Y-configuration) in patients with hilar obstruction through both transhepatic tracts and then treating them with intraluminal brachytherapy, the mean duration of stent patency (8.3 months) was not different from that in all patients who underwent intraluminal brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

Park

Cho

Kang

et al. 2001

J Korean Radiol Soc

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Self-expandable metallic stent placement was introduced in an attempt to overcome the limitations of external biliary drainage catheters (such as tube dislodgement, bile leakage, and psychologic problems) and plastic endoprostheses (such as migration, occlusion, and a traumatic implantation procedure) in treating patients Purpose: To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. Materials and Methods: Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstruction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. Results: The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (p<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8 16.1) and 8.3 (range, 0.8 17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9 8.0) and 5.0 (range, 0.9 8.4) months in those whom the procedure was not performed (p<0.05). Conclusion: Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma.

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Percutaneous Palliation of Malignant Obstructive Jaundice with the Wallstent Endoprosthesis: Follow-up and Reintervention in Patients with Hilar and Non-Hilar Obstruction

Cited by 100 publications

References 16 publications

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

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