Biliary Stent Occlusion - A Problem Solved with Self-Expanding Metal Stents?

Abstract

The main limitation in the endoscopic palliation of malignant biliary obstruction is due to stent blockage. One of the factors thought to be of importance is the diameter of the endoprosthesis. In this paper, we report the results of a multicenter European study with a one cm diameter self-expanding metal stent (Wallstent) in 103 patients with malignant biliary obstruction. Insertion of the stent following guidewire positioning was successful in 97.1% of the patients without any cases of de novo cholangitis developing after the endoscopic procedure. The median follow-up for the entire group was 145 days. In all but 3 patients, the stent expanded to more than 80% of its maximum diameter. Two patients had ongoing cholangitis after stent insertion. Long-term complications manifested by late cholangitis, were seen in 18% of the cases after a median interval of 125 days. The occlusion rate by biliary sludge was 5% after a median time period of 175 days which is substantially less than the 21% occlusion rate reported for polyethylene stents. In conclusion, our results show that the Wallstent can be easily placed in distal and mid-CBD strictures after guidewire passage, with most of the patients having a- good drainage effect. The occlusion rate by biliary sludge is significantly less than for conventional polyethylene stents, but the occlusion by tumor ingrowth is substantial. A disadvantage is the high cost of the Wallstent. Further randomized trials will be required to determine the cost-benefit ratio for the use of this stent.

Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas

“…Postoperative mortality and morbidity after open biliary bypass reportedly range from 5% to 20% [2]. Other studies have reported a mortality rate of 27%, a procedure-related morbidity rate of 13%, and a reintervention rate of 12% [1,4].…”

“…The main drawback to these methods is the substantial occlusion of these stents by tumor ingrowth [4]. Duodenal stenting is usually not considered an option for the treatment of severe duodenal obstruction in patients with invasive carcinoma of the pancreas [15].…”

Cost-Effectiveness Decision Analyses Comparing Covered to Uncovered Self-Expandable Metal Stents to Elective or on Demand Polyethylene Stent Changes in Patients with Distal Malignant Biliary Obstruction

“…AlI three stent types have been shown to be effective in the relief of obstruction and re-establishing patency of the biliary 16 tree but they differ in several aspects including physical characteristics, price, and average duration ofpatency [23][24][25].…”

“…The problems associated with PE stent dysfunction were' at least partially overcome with the advent of U-SEMS. Once fully deployed, U-SEMS reaches an internaI diameter approximately 3 times bigger than PE stents, and is less likely to be c10gged by bile plugs and biofilm [23]. Instead, U-SEMS are rather obstructed by tumor ingrowth and outgrowth which occurs on average 8-9 months after placement [35][36][37].…”

Tratamento cirúrgico da icterícia obstrutiva

“…Quando estas opções não são possíveis, a drenagem do sistema biliar com cateteres biliares externos ou próteses internas são úteis para melhorar os sintomas, porém são passíveis de obstrução. A utilização de próteses expansíveis diminuiu esta incidência 10,11 . 16 .…”