Self-expandable stainless steel braided endoprosthesis for biliary strictures.

Abstract

A new type of biliary stent was inserted in 45 patients with symptomatic biliary strictures, 40 malignant and five benign. The stent is made of stainless steel woven into a tubular mesh. It is introduced in compressed form on a 7- or 9-F delivery catheter and released at the site of the stricture. Fully open, the stent has an internal diameter of 1 cm. The 30-day mortality was 7%. The early (less than 72 hours) complication rate was 16%. Recurrent jaundice occurred in 42%; late complications of sepsis without jaundice occurred in an additional 11%. None of the stents migrated. This new design allows a large-diameter stent to be inserted percutaneously without increased risk of complications. The frequency of recurrent jaundice, however, was not less than that observed with plastic stents, but this may have reflected the spectrum of patients treated, many with hilar strictures and previous interventions.

Clinical Experience with Covered Wallstents for Biliary Malignancies: 23-Month Follow-Up

“…Clinical trials have proven the superior effectiveness of the large internal diameter of these stents for bile drainage [1], compared with the smaller diameter of conventional plastic stents [2][3][4]. Metallic stents, however, provide efficient bile drainage for a defined period of time and then undergo obstruction which can be due to tumoral overgrowth and/or ingrowth, mucosal hyperplasia induced by chronic irritation caused by the stent mesh on the epithelium, biliary incrustation, sludge, and food impaction in transpapillary stents [5][6][7][8][9][10].In an earlier multicenter study in which various types of metallic endoprostheses were implanted in 240 patients with malignant biliary obstruction, we found that stents with a large space between struts favored early tumoral occlusion of the lumen [11]. In order to provide a complete obstacle to tumoral growth, selfexpandable stents covered with a thin polymeric compound were tested on animal models [12,13], and when good biological tolerability at 12 months was documented, covered stents were used in patients [14].…”

Metal Stents for Malignant Biliary Obstruction

“…Early results of percutaneous placement of both the Gianturco stent and the Wallstent were not encouraging and appeared not to be better than results with polyethylene stents [9, 17,28]. A 40-50% rate of recurrent jaundice and cholangitis was reported.…”

Intraluminal Brachytherapy after Metallic Stent Placement in Primary Bile Duct Carcinoma

“…In a in larger patient population, furthermore, the question of whether they are related to the procedure or are due to other factors present in the patient population may be solved. Becker et al (18) and Gilliams et al (19) reported that in patients with hilar obstruction, the period of stent patency was shorter than in patients with non-hilar obstruction, but survival time was similar. However, after placing two stents (in a Y-configuration) in patients with hilar obstruction through both transhepatic tracts and then treating them with intraluminal brachytherapy, the mean duration of stent patency (8.3 months) was not different from that in all patients who underwent intraluminal brachytherapy.…”