Fully‐covered, self‐expandable metal stents (CSEMS) in malignant distal biliary strictures: Mid‐term evaluation

Bakhru, Mihir R.; Ho, Henry C.; Gohil, Vishal; Wang, Andrew Y.; Ellen, Kristi; Sauer, Bryan G.; Shami, Vanessa M.; Kahaleh, Michel

doi:10.1111/j.1440-1746.2011.06682.x

Cited by 25 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stent removal was attempted in 50 patients and was successful without complication in 39 (78%). 12 After FCSEMS placement, 17 patients proceeded to surgery and 53 patients were deemed unresectable. 28 Early experience with FCSEMS demonstrated safety and efficacy with minimal complications.…”

Section: Discussionmentioning

confidence: 99%

“…8 Although PCSEMS have been initially shown to offer better patency over uncovered SEMS, 9 a recent series failed to identify any significant difference between PCSEMS and uncovered SEMS. 12 Recently, Siddiqui et al 13 reported their single-center experience in using a fully silicon-covered SEMS (WallFlex; Boston Scientific, Natick, MA) for initial biliary decompression in patients with pancreatic cancer. These limitations led to the development of fully covered self-expanding metal stent (FCSEMS) with anchoring fins to evade tissue hyperplasia at the stent extremities and prevent migration.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of a Fully Covered Self-Expanding Metal Stent With Flared Ends in Malignant Biliary Obstruction

Kahaleh

Talreja

Loren

et al. 2013

Journal of Clinical Gastroenterology

Self Cite

View full text Add to dashboard Cite

Background and Aims: Limited data are available regarding fully covered metal stents in the management of malignant distal biliary strictures. The aim of this study was to evaluate the safety of a fully covered self-expanding metal stent (FCSEMS) with flared ends, in treating malignant biliary strictures. We report our long-term retrospective analysis from 6 centers.Methods: A total of 260 patients (142 males, median age 68 y) underwent endoscopic retrograde cholangiopancreatography with placement of FCSEMS (WallFlex; Boston Scientific, Natick, MA) for the palliation of obstructive jaundice in the setting of pancreatic adenocarcinoma (169), metastatic disease (36), cholangiocarcinoma (23), ampullary cancer (19), or other (13). Patients were evaluated clinically in follow-up and biochemical tests of liver function were obtained. Data were recorded for the following variables: patient survival, duration of stent patency, the need for subsequent biliary intervention, and complications.Results: A total of 266 FCSEMS were placed in 260 patients. There was a median survival of 100 days (range, 7 to 531 d). There was a mean follow-up of 134 ± 118 days (range, 4 to 519 d). Biliary decompression was successful in 252 patients (97%). At the end of the study period, 121 were alive with a patent stent, 65 patients died with a patent stent, 40 patients were successfully bridged to surgery, 8 patients had their patent stent removed and had no need for further stenting, and 18 patients were lost to follow-up. Five patients who had a successfully placed FCSEMS were considered a failure due to the following reason: migration (2), cholangitis (1), stent occlusion (1), and removal for management of proximal biliary obstruction (1). Two additional patients experienced migration that did not require FCSEMS removal or replacement. Stent replacement was required in 10 patients, of whom 6 had a second FCSEMS placed. The remaining 4 were in the failure group and underwent replacement with either uncovered stents or plastic stents. Other complications, managed conservatively, included pain (2), postendoscopic retrograde cholangiopancreatography pancreatitis (4), fever (1), retroperitoneal perforation (1), and postsphincterotomy bleeding (1). The mean patency duration was 328 days (SE 19.04). The patency percentage was 83% at 3 months, 63% at 6 months, and 48.5% at 12 months.Conclusions: In the management of malignant distal biliary strictures, the fully covered WallFlex stent has acceptable patency and complication rates. Further long-term prospective data are required to confirm this observation.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of a Fully Covered Self-Expanding Metal Stent With Flared Ends in Malignant Biliary Obstruction

Kahaleh

Talreja

Loren

et al. 2013

Journal of Clinical Gastroenterology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Retrieval techniques for removal of proximally migrated plastic and metal stents include forceps, a Dormia basket, snare, balloon, and a Soehendra stent retriever 12,17,18. A migrated stent may cause frequent cholangitis, as in our case, even if endoscopic revision is successful.…”

Section: Discussionmentioning

confidence: 76%

“…There was limited number of cases about removal of proximally migrated SEMS and also these migrated stents had a normal configuration. Bakhru et al12 reported one patient who experienced proximal migration 58 days following cSEMS insertion but did not describe retrieval technique. Ho et al13 reported that proximal migration of partially covered SEMS occurred in seven cases (1.7%), and migrated stents was extracted by balloon dilation combined with rat tooth extraction.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming

et al. 2013

View full text Add to dashboard Cite

Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.

show abstract

“…This may be overcome by inserting plastic stents through the lumen of the metal stent, which appears to be more cost-effective, or placement of a further mesh metal stent where technically possible. [11][12][13][14] The decision as to whether to use a plastic or metal stent will frequently depend on the patients' overall health, expected length of survival, quality of life and local expertise. Often, a plastic stent is placed initially while further diagnostic workup is underway.…”

Section: Cholangiocarcinomamentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography stents: indications, risks and novel uses

Azzopardi

2012

Gastroenterol Insights

View full text Add to dashboard Cite

Stents cannulating the common bile duct and/or the pancreatic duct are frequently used during endoscopic retrograde cholangiopancreatography in both temporary and definitive management of several conditions. While plastic stents have a high risk of occlusion within a few months, metal stents have larger diameters and may, therefore, last longer. However, they tend to have a higher initial cost and once placed, tend to be more difficult to manipulate or remove. Emerging data are now showing that the removal of covered self-expandable metal stents can be achieved relatively easily without the risks of major complications. This review article investigates the indications and complications for stent insertion, as well as the recommended type of stent for each indication

show abstract

Fully‐covered, self‐expandable metal stents (CSEMS) in malignant distal biliary strictures: Mid‐term evaluation

Abstract: CSEMS appear to provide acceptable short-term patency rates; however, their limited long-term patency and high complication rate might limit their widespread use. Further long-term prospective data are required to confirm this observation.

Cited by 25 publications

References 36 publications

Evaluation of a Fully Covered Self-Expanding Metal Stent With Flared Ends in Malignant Biliary Obstruction

Evaluation of a Fully Covered Self-Expanding Metal Stent With Flared Ends in Malignant Biliary Obstruction

Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming

Endoscopic retrograde cholangiopancreatography stents: indications, risks and novel uses

Contact Info

Product

Resources

About