Plastic Versus Self-expanding Metallic Stents for Malignant Hilar Biliary Obstruction

Perdue, David G.; Freeman, Martin L.; DiSario, James A.; Nelson, Douglas B.; Fennerty, M. Brian; Lee, John G.; Overby, Carol; Ryan, Michael E.; Bochna, Gary S.; Snady, Harry; Moore, Joseph P.

doi:10.1097/mcg.0b013e31815853e0

Cited by 175 publications

(155 citation statements)

References 33 publications

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“…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.…”

supporting

confidence: 61%

“…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.…”

supporting

confidence: 61%

“…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.…”

mentioning

confidence: 99%

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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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supporting

confidence: 61%

supporting

confidence: 61%

mentioning

confidence: 99%

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Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

Aslanian

Jamidar

2011

Dig Dis Sci

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“…External drainage, external-internal drainage and metallic stenting are choices for palliation in the percutaneous approach. In a previous prospective, multicenter, observational cohort study, metallic stenting was found to be superior to plastic stenting for hilar malignant biliary obstructions with respect to short-term results (18). In a study by Wagner et al (19), success and patency rates were found to be better for metallic stents than for plastic stents in patients with hilar malignant biliary obstructions.…”

Section: Discussionmentioning

confidence: 97%

Triple metallic stenting in hilar malignant biliary obstructions

Küçükay

Ökten²,

Yurdakul³

et al. 2010

Diagn Interv Radiol

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“…Studies have shown that SEMS outperformed plastic stents allowing higher rates of successful drainage, prolonged patency, and lower adverse outcomes such as cholangitis, stent migration, etc. [5,6]. The adequacy of unilateral or bilateral drainage continues to be debated [7,8].…”

mentioning

confidence: 99%