ePTFE/FEP stents for malignant biliary obstruction

Abstract

BackgroundBiliary obstruction due to malignant disease causes debilitating symptoms and palliation of the disease involves placement of biliary stents. Covered self-expanding metal biliary stents may provide a longer patency and a lower risk of complications and dysfunction compared to uncovered stents, making them better for patients’ quality of life and cost effectiveness. This study aims to evaluate the indications and outcomes for a group of cases where expanded polytetrafluoroethylene/fluorinated ethylene propylene (ePTFE/FEP) covered metal stents were used to palliate malignant biliary obstruction.MethodsAll cases of ePTFE/FEP-covered Viabil stent implantation in a 4-year period in a single hospital were identified and details of indications and outcomes for stent placement were recorded. Kaplan-Meier estimator analysis was used to create plots for stent patency and survival time.ResultsThe median stent patency was 173 days (standard error of the mean, SE = 54) and the median survival time was 247 days (SE = 88). No complications of stent implantation were recorded and in seven cases no dysfunction was noted. In one case, tumour ingrowth was observed, and in one other case the stent was no longer found in situ on subsequent imaging.ConclusionThe use of the ePTFE/FEP-covered Viabil stent in the palliation of malignant obstruction where indicated is promising, providing a low rate of stent dysfunction and complications. More data need to be collected to conclusively ascertain whether covered stents have a longer patency and lower complication rate compared to uncovered stents.

ePTFE‐based biomedical devices: An overview of surgical efficiency

“…The median survival in patients with covered stents was 79 and 92 days with bare stents. Another study focused on covered stents only and describes the results of a 4‐year follow‐up period 49 . A very similar median patency of the stent was observed, with 173 days, but the median survival time much higher, with 247 days.…”

Factors related to stent patency and early elimination of jaundice using bile duct stent combined with iodine-125 seed implantation in malignant obstructive jaundice

“…It is also important to select an appropriate stent placement location. Overlying stents should extend past the blocked area at both ends, otherwise there could be an increased risk of tumor overgrowth at the ends of the stent [ 4 ]. In addition, future development of novel tumor-specific biliary stents should broaden the scope of existing treatment strategies, and identify appropriate neoadjuvant therapies to improve long-term survival, develop stent patency, reduce stent migration, and reduce unnecessary re-interventions [ 29 ].…”

“…The European Society of Gastrointestinal Endoscopy (ESGE) strongly recommends the use of self-expandable metal stents (SEMS) for palliative extrahepatic biliary obstruction (high quality evidence) [3]. Nonetheless, stent re-occlusion caused by tumor growth, overgrowth, connective tissue formation, and sludge formation, affects the application of this technology, increasing the probability of re-intervention and shortening the patency of a stent [4][5][6][7]. Studies have found that biliary stents combined with iodine-125 ( 125 I) seed strand implantation might effectively relieve obstructive jaundice and prolong stent patency [8][9][10].…”