Skip to main content
SpringerLink
Log in

Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

Endoscopic biliary stenting is a well-established palliative treatment for unresectable malignant biliary strictures, for which plastic tube stents (PSs) and self-expandable metallic stents (SEMSs) are most commonly used. The efficacy of these stents has been extensively described in distal biliary strictures, but not in hilar biliary strictures. The present study aimed to compare the efficacy of PSs and SEMSs for unresectable malignant hilar biliary strictures.

Methods

From June 2004 to November 2008, 60 patients were enrolled and prospectively randomized into the PS or SEMS group.

Results

The 6-month patency rate was significantly higher in the SEMS group than in the PS group (81 vs. 20%; p = 0.0012). Kaplan–Meier analysis showed significantly longer patency in the SEMS group than in the PS group (p = 0.0002); the 50% patency period was 359 days in the SEMS group and 112 days in the PS group. There was no significant difference in the overall survival period between the PS and SEMS groups (p = 0.2834). The mean number of reinterventions for stent failures was significantly lower in the SEMS group (0.63 times/patient) than in the PS group (1.80 times/patient) (p = 0.0008). The overall total cost for the treatment was significantly lower in the SEMS group than in the PS group (p = 0.0222).

Conclusions

SEMSs were associated with a longer patency than PSs in patients with unresectable hilar biliary stricture. SEMSs were also more advantageous in reducing the number of reintervention sessions and the overall treatment cost.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.

    Article  PubMed  CAS  Google Scholar 

  2. Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207–12.

    Article  PubMed  CAS  Google Scholar 

  3. Prat F, Chapat O, Ducot B, Ponchon T, Pelletier G, Fritsch J, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47:1–7.

    Article  PubMed  CAS  Google Scholar 

  4. Arguedas MR, Heudebert GH, Stinnett AA, Wilcox CM. Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis. Am J Gastroenterol. 2002;97:898–904.

    Article  PubMed  Google Scholar 

  5. Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57:178–82.

    Article  PubMed  Google Scholar 

  6. Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53:729–34.

    Article  PubMed  CAS  Google Scholar 

  7. Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepatol. 2004;2:273–85.

    Article  PubMed  Google Scholar 

  8. Katsinelos P, Paikos D, Kountouras J, Chatzimavroudis G, Paroutoglou G, Moschos I, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. Surg Endosc. 2006;20:1587–93.

    Article  PubMed  CAS  Google Scholar 

  9. Soderlund C, Linder S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc. 2006;63:986–95.

    Article  PubMed  Google Scholar 

  10. Moss AC, Morris E, Leyden J, MacMathuna P. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev. 2007;33:213–21.

    Article  PubMed  Google Scholar 

  11. Moss AC, Morris E, Leyden J, MacMathuna P. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol. 2007;19:1119–24.

    Article  PubMed  CAS  Google Scholar 

  12. Wagner HJ, Knyrim K, Vakil N, Klose KJ. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy. 1993;25:213–8.

    Article  PubMed  CAS  Google Scholar 

  13. Perdue DG, Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, et al. Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol. 2008;42:1040–6.

    Article  PubMed  Google Scholar 

  14. Maguchi H, Takahashi K, Katanuma A, Osanai M, Nakahara K, Matuzaki S, et al. Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2007;14:441–6.

    Article  PubMed  Google Scholar 

  15. Kawakami H, Kondo S, Kuwatani M, Yamato H, Ehira N, Kudo T, et al. Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected? J Hepatobiliary Pancreat Sci. 2011;18:630–5.

    Article  PubMed  Google Scholar 

  16. Kawamoto H, Tsutsumi K, Harada R, Fujii M, Kato H, Hirao K, et al. Endoscopic deployment of multiple JOSTENT SelfX is effective and safe in treatment of malignant hilar biliary strictures. Clin Gastroenterol Hepatol. 2008;6:401–8.

    Article  PubMed  Google Scholar 

  17. Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. Gastrointest Endosc. 2010;71:195–9.

    Article  PubMed  Google Scholar 

  18. Lee BH, Choe DH, Lee JH, Kim KH, Chin SY. Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR Am J Roentgenol. 1997;168:741–5.

    PubMed  CAS  Google Scholar 

  19. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354–62.

    Article  PubMed  CAS  Google Scholar 

  20. Naitoh I, Ohara H, Nakazawa T, Ando T, Hayashi K, Okumura F, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol. 2009;24:552–7.

    Article  PubMed  Google Scholar 

  21. De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc. 2001;53:547–53.

    Article  PubMed  Google Scholar 

  22. De Palma GD, Pezzullo A, Rega M, Persico M, Patrone F, Mastantuono L, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc. 2003;58:50–3.

    Article  PubMed  Google Scholar 

  23. Dowsett JF, Vaira D, Hatfield AR, Cairns SR, Polydorou A, Frost R, et al. Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology. 1989;96:1180–6.

    PubMed  CAS  Google Scholar 

  24. Larghi A, Tringali A, Lecca PG, Giordano M, Costamagna G. Management of hilar biliary strictures. Am J Gastroenterol. 2008;103:458–73.

    Article  PubMed  Google Scholar 

  25. Costamagna G, Tringali A, Petruzziello L, Spada C. Hilar tumours. Can J Gastroenterol. 2004;18:451–4.

    PubMed  Google Scholar 

  26. Uchida N, Tsutsui K, Ezaki T, Fukuma H, Kamata H, Kobara H, et al. Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction. J Gastroenterol. 2005;40:291–6.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None of the authors have any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan

    Tsuyoshi Mukai, Masanori Nakashima, Keisuke Iwata, Tomohiro Kato & Eiichi Tomita

  2. First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan

    Ichiro Yasuda, Shinpei Doi, Takuji Iwashita & Hisataka Moriwaki

Authors
  1. Tsuyoshi Mukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ichiro Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masanori Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinpei Doi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takuji Iwashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keisuke Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomohiro Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eiichi Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hisataka Moriwaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ichiro Yasuda.

About this article

Cite this article

Mukai, T., Yasuda, I., Nakashima, M. et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci 20, 214–222 (2013). https://doi.org/10.1007/s00534-012-0508-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-012-0508-8

Keywords

Search

Navigation