Treatment of malignant biliary obstruction with polyurethane-covered Wallstents.

Hausegger, K. A.; Thurnher, Siegfried; Bodendörfer, G; Zollikofer, Christoph L.; Uggowitzer, M.; Kugler, Ch.; Lämmer, Johannes

doi:10.2214/ajr.170.2.9456954

Cited by 115 publications

(78 citation statements)

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“…Subsequently, Gore-Tex, 11 silicone, 24 and polyurethane [25][26][27][28][29][30] were evaluated as materials for the covered membrane. Miyayama et al, using polyurethane covered Gianturco stents, reported that the stent occlusion rate was only 5% due to tumour overgrowth above the stent edge and that no tumour ingrowth was observed.…”

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confidence: 99%

“…26 However, other studies suggested that a covering membrane was not effective in preventing tumour ingrowth and did not improve stent patency. [27][28][29] Hausegger et al, using polyurethane covered Wallstents, reported that the obstruction rate of those covered EMS was 33%, mainly due to tumour ingrowth, concluding that covered EMS were not superior to uncovered EMS. 29 More recently, we published a prospective consecutive study using handmade polyurethane covered Wallstents.…”

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confidence: 99%

“…[27][28][29] Hausegger et al, using polyurethane covered Wallstents, reported that the obstruction rate of those covered EMS was 33%, mainly due to tumour ingrowth, concluding that covered EMS were not superior to uncovered EMS. 29 More recently, we published a prospective consecutive study using handmade polyurethane covered Wallstents. 12 Mean periods of survival and stent patency were 233 days and 206 days, respectively.…”

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confidence: 99%

“…We used a membrane of 40-50 mm in thickness in that study while those used in the other studies were 15 mm thick. [27][28][29] We were convinced that covered EMS could overcome tumour ingrowth if the membrane was of sufficient thickness. Therefore, we conducted the present study with membranes of 50-60 mm thick.…”

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confidence: 99%

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A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

Isayama

Komatsu²,

Tsujino³

et al. 2004

Gut

585

531

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Background and aim: Covered self-expandable metal stents (EMS) were recently developed to overcome tumour ingrowth in conventional EMS. However, supporting evidence for the efficacy of covered EMS is lacking. Patients and methods: We enrolled 112 patients with unresectable distal biliary malignancies. They were randomly assigned to polyurethane covered (n = 57) or original diamond stent (n = 55). Results: Stent occlusion occurred in eight patients (14%) after a mean of 304 days in the covered group, and in 21 patients (38%) after a mean of 166 days in the uncovered group. The incidence of covered EMS occlusion was significantly lower than that of uncovered EMS (p = 0.0032). The cumulative stent patency of covered stents was significantly higher than that of uncovered stents (p = 0.0066). No tumour ingrowth occurred in the covered group while it was observed in 15 patients in the uncovered group. In subgroup analysis, the cumulative patency of the covered EMS was significantly higher in pancreatic cancer (p = 0.0363) and metastatic lymph nodes (p = 0.0354). There was no significant difference in survival between the two groups. Acute cholecystitis was observed in two of the covered group and in none of the uncovered group. Mild pancreatitis occurred in five of the covered group and in one of the uncovered group. Conclusions: Covered diamond stents successfully prevented tumour ingrowth and were significantly superior to uncovered stents for the treatment of patients with distal malignant biliary obstruction. However, careful attention must be paid to complications specific to covered self-expandable metal stents, such as acute cholecystitis and pancreatitis.

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A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

Isayama

Komatsu²,

Tsujino³

et al. 2004

Gut

585

531

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“…This predisposes the development of infections in the gallbladder or in the excluded bile segment when covered SEMS are deployed at the hepatic hylum [81]. The reported rate of cholecystitis after the deployment of covered SEMS ranges between 2.9 and 12% [82,83]. …”

Section: Treatments For Ds In Patients With Pscmentioning

confidence: 99%

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Abu-Wasel

Keough

Renfrew³

et al. 2013

Pathobiology

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The diagnosis and the treatment of dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the scientific literature on the subject is quite limited. Only level II and level III evidence is available to guide physicians managing patients with DS and PSC. For the diagnosis, intraductal endoscopic ultrasound is the most sensitive (64%) and specific (95%) test. However, the majority of cases require a combination of several different diagnostic tests, as there is no single investigation that can rule out malignancy in this group of patients. For the treatment, serial endoscopic or percutaneous dilatations provide 1- and 3-year biliary duct patency in 80 and 60% of patients, respectively. Dilatation and stenting are the most common interventions, although the optimal duration of treatment has still not been clearly defined. Bile duct resection and/or bilioenteric bypass are currently indicated only for patients with preserved liver function. For all other patients, benign DS can be treated with endoscopic dilatation with short-term stenting. This approach is effective and safe and does not increase the risk of malignant transformation or complications for liver transplant candidates. During the last decade, the use of self-expandable metallic stents for benign diseases has become an innovative option. The aim of this article is to review the diagnostic and therapeutic strategies for patients affected by PSC and DS with specific emphasis on the outcomes of patients treated with temporary stents.

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Palliation of unresectable hilar cholangiocarcinoma

2000

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Treatment of malignant biliary obstruction with polyurethane-covered Wallstents.

Cited by 115 publications

References 0 publications

A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Palliation of unresectable hilar cholangiocarcinoma

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