Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study

Suk, Ki Tae; Kim, Jae Woo; Kim, Hyun Soo; Baik, Soon Koo; Oh, Seok Jin; Lee, Se Joon; Kim, Ho Gak; Lee, Don Haeng; Won, Yong Hyun; Lee, Dong Ki

doi:10.1016/j.gie.2007.05.037

Cited by 120 publications

(87 citation statements)

References 23 publications

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“…PDT may be performed with plastic stent insertion or possibly within SEMS. Additionally, future development of drug-eluting SEMS [17] may add to the palliation and treatment options offered by the biliary endoscopist.…”

mentioning

confidence: 99%

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

Aslanian

Jamidar

2011

Dig Dis Sci

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The majority of patients with cholangiocarcinoma present with locally unresectable disease and the median survival with radiation and chemotherapy is 7-12 months. The endoscopic palliation of inoperable hilar cholangiocarcinoma remains one of the more challenging cases for the biliary endoscopist. The endoscopist must define the anatomy without injecting contrast into ducts that will not be drained, achieve guide-wire access for unilateral or bilateral stent placement and determine what type of stent-plastic or self-expanding metal (SEMS), will best serve the patient to relieve pain and jaundice and prevent cholangitis.Raju et al.[1] present a retrospective review of 100 patients who underwent endoscopic plastic or SEMS placement for inoperable hilar cholangiocarcinoma. Patients were regularly followed to death or reintervention, and stent patency and survival were examined. In 48 patients uncovered (as expected due to the hilar location of obstruction) SEMS were placed, with plastic stents (at least one of which was 10 French) in the other 52 patients. The Bismuth Classification of lesions was similar between the groups. There was however, a greater number of Type 3 and 4 cases that received plastic stents (73.1% vs. 56.3%), potentially favoring a better outcome with SEMS. The technical success rate was high in both groups (95.8% vs. 94.2%). Bilateral stenting was performed successfully in 20/23 plastic stent patients and 5/5 SEMS. The SEMS group demonstrated significantly better stent patency (5.56 vs. 1.86 months) and required fewer re-interventions for stent obstruction (1.53 vs.4.6). The complication rate was similar in both groups (8.3% SEMS and 7.7% plastic) and there was a non-significant trend towards greater survival in the SEMS group (9.08 vs. 8.22 months). During the study time period, routine stent changes in patients with plastic stents were not performed; however, the median patency was only 1.5 months. No difference between the patency of straight and pigtail plastic stents was seen, nor was there a difference between unilateral and bilateral plastic stents or SEMS. All re-interventions were performed endoscopically, nine patients with plastic stents were converted to SEMS and plastic stents were placed within SEMS in four patients.The results of Raju et al. are similar to those of prior studies identifying less stent failure with the use of SEMS versus plastic stents for hilar tumors [2,3]. There is scant information in the way of randomized comparisons between plastic and metal stents. A study by Wagner et al.[2] is the only prospective, randomized study. Twenty patients were randomized between metal stents placed percutaneously or endoscopic stents placed by a combination of endoscopic-percutaneous technique. Perdue et al.[3] reviewed a multicenter database of 62 consecutivelyreported endoscopically-placed metal or plastic stents for hilar obstruction. Outcomes in favor of metals stents were reported in both studies.

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confidence: 99%

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

Aslanian

Jamidar

2011

Dig Dis Sci

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“…As explained earlier, DTX has insignificant skin reactions on IV administration. Also, paclitaxel (same chemical class as that of DTX) has been evaluated in preclinical (16)(17)(18)(19) as well as clinical studies (20)(21)(22) for stent development, but all the reports indicate manageable side effects like inflammation, fibrosis, etc. One way forward for DTX use would be to combine it with a drug having a complementary mode of action and nonoverlapping toxicity; this will reduce the dose as well as increase efficacy.…”

Section: Modified Formulation and The In Vivo Activitymentioning

confidence: 99%

In Vitro and In Vivo Assessment of Docetaxel Formulation Developed for Esophageal Stents

et al. 2016

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Abstract. Esophageal cancer (EC) mostly affects the elderly population and is frequently diagnosed at an advanced stage. Self-expanding metal stents (SEMS) are the most popular mode of palliation, but they are associated with reocclusion caused by tumor growth. To overcome this problem, docetaxel (DTX)-loaded polyurethane formulations were prepared for stent application. The films were evaluated against the cancer cell lines, OE-19 and OE-21, and normal esophageal cell line Het-1A. The DTX and the formulations were evaluated in vitro for the cytotoxicity and in vivo in nude mice. It was found that DTX and the formulations have a weak activity against the EC cell lines and an even weaker activity against Het-1A cell line. Preliminary in vivo studies showed skin toxicity in nude mice necessitating modification of the formulation. Reevaluation in a mouse xenograft model resulted in toxicity at high dose formulations while the low dose formulation exhibited modest advantage over commercial IV formulation; however, there was no significant difference between the commercial IV and blank formulation. DTX combination with an anti-cancer agent having complementary mode of action and non-overlapping toxicity could yield better outcome in future.

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“…Mean patency of drug-eluting stents were 429 days with 100% patency at 3 months, 71% patency at 5 months, and 36% patency at 12 months. 34 Song et al…”

Section: Drug-eluting Stentsmentioning

confidence: 99%

An Update to Hepatobiliary Stents

Moy¹,

Bir²

2015

JCTH

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Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simple plastic stent technology has evolved significantly to include uncovered, partially covered, and fully covered self-expanding metal stents (SEMS) as well as magnetic, bioabsorbable, drug-eluting, and antireflux stents.

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Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study

Cited by 120 publications

References 23 publications

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

In Vitro and In Vivo Assessment of Docetaxel Formulation Developed for Esophageal Stents

An Update to Hepatobiliary Stents

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