Use of hot-tip laser probes to recanalize occluded expandable metallic biliary endoprostheses.

Lossef, Steven V.; Druy, E M; Jelinger, Eric; Fleischer, David E.; Barth, Klemens H.

doi:10.2214/ajr.158.1.1309219

Cited by 24 publications

(15 citation statements)

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“…Metallic stents provide a larger lumen than plastic stents for drainage and permit stent placement in multiple ducts, this being especially important in hilar structures. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] Controlled studies have shown that metallic stents were superior to plastic endoprostheses with regard to patency and costeffectiveness. 49 However, the results of initial studies of the use of metallic stents were disappointing because of the high rate of stent occlusion.…”

Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

“…49 However, the results of initial studies of the use of metallic stents were disappointing because of the high rate of stent occlusion. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] The main reasons for stent occlusion were sludge formation, tumor overgrowth, tumor ingrowth, and protrusion of granulation tissue. 50,51,63 The management of occluded stents includes the insertion of other stents [52][53][54] and mechanical cleaning of the debris.…”

Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

“…50,51,63 The management of occluded stents includes the insertion of other stents [52][53][54] and mechanical cleaning of the debris. 53,54 Recanalization by diathermy, and by 54 hot-tip laser probes, 55 and electrocoagulation 56 and microwave coagulation 57,58 are performed for tumor ingrowth. Accurate assessment of the cause of stent occlusion by diagnostic imaging is important in evaluating the effectiveness and drawbacks of these interventions.…”

Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

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Diagnosis and non-surgical treatment of bile duct carcinoma: developments in the past decade

Tamada

Sugano

2000

Journal of Gastroenterology

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In the past decade, ultrasonography and magnetic resonance cholangiography have become useful modalities for the screening of bile duct cancer. Intraductal ultrasonography, using a thin-caliber (2.0 to 2.4 mm in diameter) and high-frequency (15 to 20 MHz) probe, has become a promising modality in assessing locoregional staging. For interventional therapy of unresectable bile duct carcinoma, metallic stents also became an excellent modality. However, tumor ingrowth and overgrowth into the mesh of stents are problems to be solved, and external radiation therapy is widely conducted to control the tumor. To improve the limitations of external radiation, brachytherapy, photodynamic therapy, and microwave coagulation therapy are conducted. However, these modalities are available in only a limited number of institutions even now. To predict the prognosis of the patients, approaches using molecular biology must be established.

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Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

Section: Biliary Stenting For Unresectable Bile Duct Cancermentioning

confidence: 99%

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Diagnosis and non-surgical treatment of bile duct carcinoma: developments in the past decade

Tamada

Sugano

2000

Journal of Gastroenterology

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“…6,7,8). There was a significantly lower rise in temperature with the stent in place than without a stent at 2 and 5 mm from the electrode at 40 watts (p<O.OOOl) and at 5 mm from the electrode at 30 watts (p=O.O006) (Figs.…”

Section: Resultsmentioning

confidence: 88%

Possible Application of Microwave Coagulation Therapy for Recanalising Tumor‐occluded Self‐expandable Metallic Stents

Maetani

Ogawa

Sato

et al. 1999

Digestive Endoscopy

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There is no consensus regarding optimal management of tumor ingrowth through self-expandable metallic stents in the biliary system. We investigated the possibility that microwave therapy could be used to treat stent occlusion. We evaluated the thermal properties of a muscle equivalent phantom subjected to microwave energy. The temperature of the phantom was continuously monitored using the probe sensor of a fiberoptic thermometer embedded into the phantom model at different distances from a microwave electrode with and without a stent in place. The temperature of the phantom increased incrementally as the power increased from 30 to 50 watts at distances 2 and 5 mm from the electrode (peO.01). With the goal of achieving adequate local heating without excessive distant heating, the most effective power was 40 watts. There was a significantly lower rise in temperature with stent in place than that without stent at 2 and 5 mm from the electrode at 40 watts. The temperature increase when the tip of the electrode was kept in contact with the stent was significantly smaller than when the conductor tip was kept apart from the stent (~~0 . 0 5 ) .Using this method, the microwave energy did not induce destruction of the stent filament. In a muscle equivalent phantom model, the temperature changes induced by microwave energy were consistent with possible safe and effective application of this modality to recanalization of occluded metallic stents. (Dig Endosc 1999; 11 : 158-164) Key words: self-expandable metallic stent, tumor ingrowth, microwave coagulation, t h e r m a l effect Expandable metallic stents have been introduced for the palliation of malignant biliary stenoses. This method has the advantage over the conventional tube stent of a longer patency." '' However, major complications such as tumor ingrowth and overgrowth still remain, and there remains no consensus regarding optimal management of these complications. Endoscopic treatment for Manuscript

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“…Generally, the stent's patency lasts between 4 and 8 months [1]. If patients outlive this period, reintervention with reopening of the EMS by laser, placement of an additional EMS, or placement of an external drainage catheter becomes necessary [6]. If the indwelling EMS can be easily removed, it can simply be replaced without adding another layer of metal over the existing stent and perhaps allowing more frequent exchanges.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent

Sawada

Kobayashi

Tanigawa

et al. 1997

Cardiovasc Intervent Radiol

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Use of hot-tip laser probes to recanalize occluded expandable metallic biliary endoprostheses.

Cited by 24 publications

References 0 publications

Diagnosis and non-surgical treatment of bile duct carcinoma: developments in the past decade

Diagnosis and non-surgical treatment of bile duct carcinoma: developments in the past decade

Possible Application of Microwave Coagulation Therapy for Recanalising Tumor‐occluded Self‐expandable Metallic Stents

Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent

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