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. 1995 Apr;36(4):618–621. doi: 10.1136/gut.36.4.618

A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction.

S O'Brien 1, A R Hatfield 1, P I Craig 1, S P Williams 1
PMCID: PMC1382508  PMID: 7537708

Abstract

Effective palliation of malignant biliary obstruction with conventional 10 or 12 French gauge straight polyethylene endoprostheses is limited by stent occlusion, which typically occurs four to five months after insertion. Short term follow up studies of self expanding metal stents (Wallstent, Schneider, UK) in the treatment of patients with malignant biliary obstruction have shown that their use is associated with fewer episodes of stent occlusion compared with plastic stents. There are few data, however, on the longterm patency and durability of metal stents in malignant disease. Between May 1989 and May 1992, metal stents were inserted in 28 patients with malignant bile duct strictures secondary to ampullary tumour (n = 10), pancreatic carcinoma (n = 10), cholangiocarcinoma (n = 7), and porta hepatis nodes from colorectal carcinoma (n = 1). The follow up of these patients until May 1993 is reported with a median follow up of 14.6 months. Twenty two of 28 (78.6%) patients remained free of jaundice or cholangitis. The median period of stent patency was 8.2 months (range 1.0-32.5). Thirteen patients represented with jaundice or cholangitis and endoscopic retrograde cholangiopancreatography showed evidence of stent occlusion due to tumour ingrowth. Successful clearance of metal stents was achieved by balloon trawling, or insertion of a polyethylene stent. In conclusion, metal stents provide improved longterm palliation for patients with malignant biliary strictures with fewer episodes of occlusion compared with conventional stents.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bethge N., Wagner H. J., Knyrim K., Zimmermann H. B., Starck E., Pausch J., Vakil N. Technical failure of biliary metal stent deployment in a series of 116 applications. Endoscopy. 1992 Jun;24(5):395–400. doi: 10.1055/s-2007-1010506. [DOI] [PubMed] [Google Scholar]
  2. Cotton P. B. Endoscopic methods for relief of malignant obstructive jaundice. World J Surg. 1984 Dec;8(6):854–861. doi: 10.1007/BF01656025. [DOI] [PubMed] [Google Scholar]
  3. Davids P. H., Groen A. K., Rauws E. A., Tytgat G. N., Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992 Dec 19;340(8834-8835):1488–1492. doi: 10.1016/0140-6736(92)92752-2. [DOI] [PubMed] [Google Scholar]
  4. Gillams A., Dick R., Dooley J. S., Wallsten H., el-Din A. Self-expandable stainless steel braided endoprosthesis for biliary strictures. Radiology. 1990 Jan;174(1):137–140. doi: 10.1148/radiology.174.1.2294541. [DOI] [PubMed] [Google Scholar]
  5. Huibregtse K., Carr-Locke D. L., Cremer M., Domschke W., Fockens P., Foerster E., Hagenmüller F., Hatfield A. R., Lefebvre J. F., Liquory C. L. Biliary stent occlusion--a problem solved with self-expanding metal stents? European Wallstent Study Group. Endoscopy. 1992 Jun;24(5):391–394. doi: 10.1055/s-2007-1010505. [DOI] [PubMed] [Google Scholar]
  6. Huibregtse K., Cheng J., Coene P. P., Fockens P., Tytgat G. N. Endoscopic placement of expandable metal stents for biliary strictures--a preliminary report on experience with 33 patients. Endoscopy. 1989 Nov;21(6):280–282. doi: 10.1055/s-2007-1012969. [DOI] [PubMed] [Google Scholar]
  7. Huibregtse K., Katon R. M., Coene P. P., Tytgat G. N. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986 Oct;32(5):334–338. doi: 10.1016/s0016-5107(86)71878-6. [DOI] [PubMed] [Google Scholar]
  8. Irving J. D., Adam A., Dick R., Dondelinger R. F., Lunderquist A., Roche A. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology. 1989 Aug;172(2):321–326. doi: 10.1148/radiology.172.2.2664861. [DOI] [PubMed] [Google Scholar]
  9. Knyrim K., Wagner H. J., Pausch J., Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993 Mar;25(3):207–212. doi: 10.1055/s-2007-1010294. [DOI] [PubMed] [Google Scholar]
  10. Lee M. J., Dawson S. L., Mueller P. R., Krebs T. L., Saini S., Hahn P. F. Palliation of malignant bile duct obstruction with metallic biliary endoprostheses: technique, results, and complications. J Vasc Interv Radiol. 1992 Nov;3(4):665–671. doi: 10.1016/s1051-0443(92)72920-0. [DOI] [PubMed] [Google Scholar]
  11. Morita S. [Biliary endoprosthesis of malignant biliary obstruction using expandable metallic stent--preliminary clinical evaluation]. Nihon Igaku Hoshasen Gakkai Zasshi. 1992 May 25;52(5):623–640. [PubMed] [Google Scholar]
  12. Salomonowitz E. K., Adam A., Antonucci F., Stuckmann G., Zollikofer C. L. Malignant biliary obstruction: treatment with self-expandable stainless steel endoprosthesis. Cardiovasc Intervent Radiol. 1992 Nov-Dec;15(6):351–355. doi: 10.1007/BF02734117. [DOI] [PubMed] [Google Scholar]
  13. Speer A. G., Cotton P. B., MacRae K. D. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc. 1988 Sep-Oct;34(5):412–417. doi: 10.1016/s0016-5107(88)71407-8. [DOI] [PubMed] [Google Scholar]
  14. Speer A. G., Cotton P. B., Russell R. C., Mason R. R., Hatfield A. R., Leung J. W., MacRae K. D., Houghton J., Lennon C. A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987 Jul 11;2(8550):57–62. doi: 10.1016/s0140-6736(87)92733-4. [DOI] [PubMed] [Google Scholar]
  15. Wagner H. J., Knyrim K., Vakil N., Klose K. J. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy. 1993 Mar;25(3):213–218. doi: 10.1055/s-2007-1010295. [DOI] [PubMed] [Google Scholar]

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