Comparison of double-layer large-diameter and conventional small-diameter plastic stents for preoperative biliary drainage in resectable distal malignant biliary obstruction

Abstract

the use of a plastic stent (pS) in resectable patients with distal malignant biliary obstruction (DMBo) is uncommon due to the high failure rate of this method. This study evaluated the efficacy and safety of a double-layer, large-diameter pS as a bridge to surgery compared with a conventional pS. This was a single-center retrospective cohort study. In total, 129 consecutive patients with DMBO underwent pancreaticoduodenectomy between January 2011 and March 2018. Fifty-five patients who preoperatively underwent plastic biliary drainage were enrolled. the patients were divided into two groups based on stent diameter: a large-diameter plastic stent (LpS) group and a small-diameter plastic stent (SpS) group. the primary endpoint was the stent patency period, and the secondary endpoint was the medical cost. Thirty-six patients received SPSs; 19 patients received LPSs. The patency rate until surgery was significantly higher in the LPS group than in the SPS group (89.5% vs. 41.7%, P = 0.0006). Multivariate analysis revealed that LPS use was significantly associated with sufficient stent patency. The total cost of LPS use was significantly lower than that of SPS use. LPSs had longer patency and reduced medical costs than SpSs. LpSs may be suitable for patients with DMBo who are scheduled to undergo surgery. Distal malignant biliary obstruction (DMBO) is a frequent complication caused by different types of cancer. Among them, pancreatic ductal adenocarcinoma (PDAC) and cholangiocarcinoma are considered the two primary biliary stenosis malignancies. Approximately 70% of patients with PDAC show biliary obstruction 1. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend routine preoperative biliary drainage in patients with MBO 2. Biliary drainage to prevent cholangitis and severe jaundice is suggested as an adequate indication because a high level of bilirubin is associated with a high risk of postoperative complications 3. The ESGE recommends that biliary drainage for DMBO be performed via endoscopic retrograde cholangiopancreatography (ERCP) rather than via surgery or percutaneously 2 , and stenting by ERCP is a standard practice of biliary drainage for DMBO 4. Recent ESGE guidelines strongly recommend the endoscopic placement of a 10-mm-diameter self-expandable metallic stent (SEMS) for preoperative biliary drainage of MBO because SEMSs are associated with a lower rate of reintervention than is the use of a plastic stent (PS) and based on a meta-analysis, there is no difference in

Newer Stents for Unresectable Malignant Distal Biliary Obstruction: Striving for Perfection!

“…In their study also, the new double-layer plastic stent had higher stent patency rate compared with 7F or 8.5F conventional plastic stents. 9 These studies show that changing stent design and diameter might give the answer for optimal plastic stent placement in patients with distal biliary obstruction. Similar to plastic stents, the risk of acute cholecystitis and migration is the major shortcoming in current FCSEMS designs.…”

“…7 Recently, a double-layer stent design has been developed which has shown better stent patency rates compared with conventional plastic stents. 8,9 In that stent, the inner layer is made up of fluorine coating, which has a water-repellant property, to minimize the bile adhesion and the outer rigid material provides stiffness necessary to guide smooth insertion. 10 Similar to plastic stents, designs of metallic stents have also evolved in recent years to increase its patency and reduce the risk of migration.…”

Evaluation of the Character of Microbial Flora at the Stages of Treatment in Patients With Malignant Obstructive Jaundice

“…ОЖ пухлинного генезу є важливим клінічним діагнозом, що характеризується високим ризиком розвитку бактеріальної колонізації [15]. Приблизно у 70% пацієнтів з пухлинами ПБЗ спостерігається ОЖ [16], що проявляється гострим холангітом (ГХ) більше, ніж у 30% випадків [17]. Наявність ГХ, асоціюється з позитивною жовчною культурою в 59-93% випадках [15].…”