Article

Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center.

Yale University School of Medicine, Department of Internal Medicine, 333 Cedar St, 1080 LMP, New Haven, CT 06520-8019, USA.
Gastrointestinal endoscopy (Impact Factor: 6.71). 07/2008; 68(4):676-82. DOI: 10.1016/j.gie.2008.03.1064
Source: PubMed

ABSTRACT A significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management.
Our purpose was to review the management and outcomes of patients with biliary SEMS occlusion.
Retrospective chart review at a single tertiary care hospital.
From January 1999 to October 2005, a total of 90 patients had SEMSs placed for malignant biliary obstruction, and 27 of these occluded.
Technical success of treating SEMS occlusion, stent patency and need for reintervention, and incremental cost analysis.
A total of 60 ERCPs were performed to treat SEMS occlusions in 27 patients. The success rate was 95%; however, 52% of patients eventually required more than 1 intervention. Placing a second SEMS through the existing SEMS (n = 14) provided the lowest reocclusion rate (43% vs 55% and 100%), the longest time to reintervention (172 days vs 66 and 43 days, P = .03), and a trend toward longer survival (285 days vs 188 and 194 days) compared with plastic stent and mechanical balloon cleaning, respectively. Incremental cost analysis showed both uncovered SEMSs and plastic stents to be cost effective strategies.
Small number of patients, retrospective study.
Treatment of biliary SEMS occlusion with SEMS insertion provides for longer patency and survival, decreases the number of subsequent ERCPs by 50% compared with plastic stents, and is cost-effective.

0 Bookmarks
 · 
62 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Malignant biliary obstruction results in jaundice, often with symptoms that decrease the quality of life. Biliary stent placement has largely supplanted surgical bypass for palliation of malignant biliary obstruction. Traditional rigid plastic stents are commonly used, inexpensive and easily removed, although with limited duration of stent patency. Self-expandable metal stents (SEMS) attain larger luminal diameters and provide longer patency than traditional rigid plastic stents in patients with distal bile duct obstruction. SEMS are composed of a variety of metals and can be uncoated, partially covered, or fully covered. Data do not support a prolongation of patency with covered SEMS for distal obstruction, although they have the potential for removability. The data to support SEMS for palliation of hilar biliary obstruction are not as convincing and reintervention for stent occlusion can be difficult. In this article, the design and performance of expandable metal stents for treatment of malignant biliary obstruction will be reviewed.
    Expert Review of Medical Devices 09/2010; 7(5):681-91. · 2.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Malignant biliary obstruction can arise from intrahepatic, extrahepatic, and hilar locations from either primary or metastatic disease. Biliary-enteric surgical bypass has been surpassed in the last 20 years by endoscopic balloon dilation and stenting. The goal of stenting for biliary decompression is to palliate obstructive symptoms; it has not been shown that survival is affected by stenting alone. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have been evaluated and show promise. Both therapies seem to be safe and effective in the treatment of malignant bile duct strictures but are in need of prospective studies of longer duration.
    Gastrointestinal endoscopy clinics of North America 04/2013; 23(2):313-31.
  • Gastrointestinal endoscopy 03/2013; 77(3):319-27. · 6.71 Impact Factor