1. Partially covered self-expanding metal stent for unresectable malignant extrahepatic biliary obstruction: Results of a large prospective series
- Author
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Gómez-Oliva C., Guarner-Argente C., Concepción M., Jiménez F.J., Rodríguez S., Gonzalez-Huix F., Mugica F., Cabriada J.L., Rodríguez C., and Aguilar C.G.
- Subjects
cannulation ,iatrogenic disease ,endoscopic retrograde cholangiopancreatography ,Kaplan Meier method ,bile duct obstruction ,pancreatitis ,middle aged ,patient safety ,acute cholecystitis ,postoperative complication ,Aged, 80 and over ,evaluation ,predictive value ,cancer adjuvant therapy ,article ,clinical trial ,methodology ,cancer palliative therapy ,biliary tract tumor ,prosthesis failure ,aged ,cholangitis ,female ,tumor growth ,Biliary Tract Neoplasms ,priority journal ,digestive system hemorrhage ,obstructive jaundice ,prospective study ,endoscopic therapy ,palliative therapy ,bare metal stent ,survival ,cancer chemotherapy ,male ,pancreas cancer ,cancer radiotherapy ,human ,gallbladder perforation ,partially covered self expanding metal stent ,stent migration ,clinical effectiveness ,digestive system perforation ,extrahepatic bile duct obstruction ,major clinical study ,mortality ,multicenter study ,Cholangiopanc ,inoperable cancer ,treatment outcome ,stent ,stent patency - Abstract
Background: Endoscopic biliary stenting is a well-established palliative treatment in patients with unresectable malignant biliary strictures. Obstruction of uncovered selfexpanding metal stent (SEMS) due to tumor ingrowth is the most frequent complication. Partially covered SEMS might increase stent patency but could favor complications related to stent covering, such as pancreatitis, cholecystitis, and migration. The aim of this study was to evaluate the efficacy and safety of partially covered SEMS in patients with an unresectable malignant biliary stricture. Methods: Patients with malignant extrahepatic biliary obstruction treated endoscopically with partially covered SEMS were included in this multicenter, prospective, nonrandomized study. Results: One hundred ninety-nine patients were endoscopically treated with partially covered SEMS in 32 Spanish hospitals. Clinical success after deep cannulation was 96%. Early complications occurred in 4% (3 pancreatitis, 2 cholangitis, 1 hemorrhage, 1 perforation, and 1 cholecystitis). Late complications occurred in 19.5% (18 obstructions, 10 migrations, 6 cholangitis without obstruction, 3 acute cholecystitis, and 2 pancreatitis), with no tumor ingrowth in any case. Median stent patency was 138.9 ± 112.6 days. One-year actuarial probability of stent patency was 70% and that of nonmigration was 86%. Multivariate analysis showed adjuvant radio- or chemotherapy as the only independent predictive factor of stent patency and previous insertion of a biliary stent was the only predictive factor of migration. Conclusions: The partially covered SEMS was easily inserted, had a high clinical success rate, and prevented tumor ingrowth. The incidence of possible complications related to stent coverage, namely, migration, pancreatitis, and cholecystitis, was lower than in previously published series. © Springer Science+Business Media, LLC 2011.
- Published
- 2012
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