Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study

Kullman, Eric; Frozanpor, Farshad; Söderlund, C; Linder, Stefan; Sandström, Per; Lindhoff-Larsson, Anna; Tóth, Ervin; Lindell, Gert; Jonas, Eduard; Freedman, Jacob; Ljungman, Martin; Rudberg, Claes; Ohlin, Bo; Zacharias, Rebecka; Leijonmarck, Carl-Eric; Teder, Kalev; Ringman, Anders; Persson, Gunnar; Gözen, Mehmet; Eriksson, Olle

doi:10.1016/j.gie.2010.07.036

Cited by 286 publications

(250 citation statements)

References 46 publications

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“…It is important to consider that obstruction resolution depends on the stent remaining in place, which depends on the type of stent used. Totally covered SEMS appear to migrate more frequently (3%-12%) compared to uncovered SEMS (< 1%) (11)(12)(13)(14). In our series, migration occurred in 9.1% (n = 2) of those with covered SEMS, although this was not statistically significant (p = 0.101).…”

Section: Discussioncontrasting

confidence: 70%

“…Two clinical trials did not detect a difference when comparing totally covered SEMS with uncovered SEMS (11,16). This is perhaps due to the fact that most patients with pancreatobiliary tumors are first evaluated in advanced stages of the disease and die within the first 6 months of palliation without evidence of stent dysfunction; it is, thus, difficult to establish a difference when comparing both types of stents.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Carmona¹,

Lárraga²,

Guerrero³

et al. 2016

Rev Esp Enferm Dig

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Background and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction.Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46).Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476).Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Carmona¹,

Lárraga²,

Guerrero³

et al. 2016

Rev Esp Enferm Dig

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“…The risks of covered stent placement in biliary system include isolation of other nondrained ducts, which may cause cholangitis, occlusion of pancreatic duct which may cause pancreatitis and stent migration. 10,13 In our patient, the PTBD catheter was draining only ducts of segments 2 and 3 as the disease had already involved primary and bilobar secondary biliary confluence and hence there was no increase in risk of ductal isolation. This was confirmed by doing ultrasonography 3 days after stent placement.…”

Section: Discussionmentioning

confidence: 83%

Delayed Severe Hemobilia Due to Bilio-venous Fistula After Percutaneous Transhepatic Biliary Drainage: Treatment With Covered Stent Placement

Madhusudhan¹,

Dash

Afsan

et al. 2016

Journal of Clinical and Experimental Hepatology

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Biliovenous fistula occurs due to development of a communication between hepatic duct and portal vein branches and is a rare complication of percutaneous transhepatic biliary drainage (PTBD). Most of them are self-limiting and only occasionally they need interventional management. Placement of biliary stent graft is a viable option. We present here a case of a 56-year-old male with carcinoma of gall bladder presenting with hemodynamic shock due to severe hemobilia after PTBD and treated successfully by biliary covered stent placement. ( J CLIN EXP HEPATOL 2016;6:241-243) P ercutaneous transhepatic biliary drainage (PTBD) is a standard treatment for improvement of liver functions and relief of jaundice in patients of malignant biliary obstruction.1 The technique has a technical success rate of more than 90% and clinical success rate of more than 75%.2,3 Complications associated with the procedure are seen in about 10% of patients and severe hemorrhage is seen in about 2.3% cases. 4,5 The etiology of severe after PTBD include arterio-biliary fistula, porto-biliary fistula, pseudoaneurysms and deranged coagulation parameters.6,7 Biliovenous fistula is a rare complication, seen in less than 0.5% cases, with few cases reported in literature. 4,[8][9][10][11][12] These cases are either managed conservatively or by radiological interventions in the form of balloon occlusion, coiling or covered stent placement depending on patient's hemodynamic status. 4,[8][9][10][11] We report a case of 56-year-old male with carcinoma of gall bladder, who developed bilio-venous fistula 3 weeks after PTBD and presented with features of hemodynamic shock and was managed by placement of biliary covered stent. CASE REPORTA 56-year-old male patient presented to gastrointestinal surgery out patient clinic with history of jaundice and pain abdomen for 2 months. Clinical examination revealed icterus. Per-abdominal examination was unremarkable. Ultrasonography was done, which showed a mass replacing the gall bladder with dilatation of bilobar intrahepatic biliary ducts. Subsequently, contrast enhanced computed tomography (CT) scan was done, which showed a heterogeneously enhancing mass replacing the gall bladder and involving the primary biliary and right secondary biliary confluence and right hepatic artery. Since, the volume of segments 2 and 3 of liver was small, surgery was deferred. The patient was referred for biliary drainage. Left sided PTBD was done and an 8.3-F ring biliary catheter (Cook, Bloomington) was inserted for initial internal/external drainage. One week later, the external end of the catheter was capped to allow internal drainage of bile. After two weeks, the patient presented to the emergency department with short history of blood leaking from the sides of catheter. On examination, the patient's blood pressure was 100/76 mmHg, pulse was 112/min and respiratory rate was 12/min. His liver function tests showed total bilirubin of 4.6 mg/dL, serum albumin of 1.5 g/dL, alkaline phosphatase of 350 IU, aspartate transaminase o...

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“…6 However, whether uncovered or covered SEMS have superior stent patency period remains controversial. [7][8][9][10] One of the reasons for this may be because of differences between covering materials in membrane biodurability under long-term exposure to bile juice. 11 The reason that the stent patency period was shorter and the patency rate was lower than expected in some clinical studies of covered SEMS may be due to cracks in the covering membrane with subsequent tumor ingrowth (Fig.…”

Section: Covering Membranementioning

confidence: 99%

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent

Yang¹,

Moon²,

You³

et al. 2016

Korean J Pancreas Biliary Tract

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Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque markers, are discussed in this review. What we know about the physical and mechanical properties of the SEMS is very important. With an understanding of the basic knowledge of metal stents, hurdles such as stent occlusion, migration, and kinking can be overcome to develop more ideal SEMS.

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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study

Cited by 286 publications

References 46 publications

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Delayed Severe Hemobilia Due to Bilio-venous Fistula After Percutaneous Transhepatic Biliary Drainage: Treatment With Covered Stent Placement

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent

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