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Biliary Malignancy: Distal

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Self-Expandable Stents in the Gastrointestinal Tract

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Abstract

Self-expandable metal stents (SEMSs) have been shown to provide superior palliation for unresectable biliary obstruction when compared to plastic stents (PSs). Most studies have confirmed that SEMS patency is twice as long as that of PSs, with a decreased need for hospital readmission and endoscopic re-intervention for recurrent biliary obstruction. It has been over 10 years since a covered SEMS (CSEMS) was first introduced; however, clinical data are still insufficient to conclude that the covered SEMS is more beneficial than the bare type. Tumor ingrowth is the most common cause of occlusion in bare SEMS, whereas impaction of food or sludge is the most common cause in CSEMSs. No studies have demonstrated significant improvement in stent patency or patient survival; thus, so far, it is still controversial which type of SEMS is superior. Although SEMSs have longer stent patency than PSs, the stent occlusion rate for both covered and uncovered SEMS is between 20% and 38%. Various stent-related complications including stent migration, cholangitis, cholecystitis, pancreatitis, and hemobilia have been reported. Recently, modifications of SEMS design have been made to reduce these complications. Through these efforts, significant advances in flexibility and conformability of SEMS have reduced the rate of stent migration. In addition, phase II and III clinical trials of drug-eluting stent (DES) with antitumor effect are currently in progress. Functioning stents with improved design are expected to be available in the future. In this chapter, outcomes (plastic vs. SEMS, bare vs. covered SEMS), complications, and future of SEMS for biliary malignant obstruction are reviewed.

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References

  1. Soehendra N, Reynders-Frederix V. Palliative biliary duct drainage. A new method for endoscopic introduction of a new drain. Dtsch Med Wochenscher. 1979;104:206–7.

    Article  CAS  Google Scholar 

  2. Levy MJ, Baron TH, Gostout CJ, et al. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stent: an evidence-based approach. Clin Gastroenterol Hepatol. 2004;2:273–85.

    Article  PubMed  Google Scholar 

  3. Cipolletta L, Rotondano G, Marmo R, et al. Endoscopic palliation of malignant obstructive jaundice: an evidence-based review. Dig Liver Dis. 2007;39:375–88.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Carr-Locke DL, Ball TJ, Connors PJ, et al. Multicenter, randomized trial of Wallstent biliary endoprosthesis versus plastic stents. Gastrointest Endosc. 1993;39:A310.

    Google Scholar 

  6. 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 

  7. 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 

  8. Yon WJ, Ryu JK, Yang KY, et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: and emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc. 2009;70:284–9.

    Article  Google Scholar 

  9. Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomized 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 

  10. Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.

    Article  PubMed  Google Scholar 

  11. Park DH, Kim M-H, Choi JS, et al. Covered versus uncovered Wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol. 2006;4:790–6.

    Article  Google Scholar 

  12. Telford JJ, Carr-Locke DL, Baron TH, et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 2010;72:907–14.

    Article  PubMed  Google Scholar 

  13. Kullman E, Frozanpor F, Soderlund C, et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 2010;72:915–23.

    Article  PubMed  Google Scholar 

  14. Gwon DI, Ko G-Y, Kim JH, et al. A comparative analysis of PTFE-covered and uncovered stents for palliative treatment of malignant extrahepatic biliary obstruction. AJR Am J Roentgenol. 2010;195:W463–9.

    Article  PubMed  Google Scholar 

  15. Isayama H, Nakai Y, Toyokawa Y, et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc. 2009;70:37–44.

    Article  PubMed  Google Scholar 

  16. Yang KY, Ryu JK, Seo JK, et al. A comparison of the Niti-D biliary uncovered stent and the uncovered Wallstent in malignant biliary obstruction. Gastrointest Endosc. 2009;70:45–51.

    Article  PubMed  Google Scholar 

  17. Loew BJ, Jowell DA, Sandeers MK, et al. Comparative performance of uncoated, self-expanding metal biliary stents of different design in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc. 2009;70:445–53.

    Article  PubMed  Google Scholar 

  18. Shah RJ, Howell DA, Desilets DJ, et al. Multicenter randomized trial of the spiral Z-stent compared with the Wallstent for malignant biliary obstruction. Gastrointest Endosc. 2003;57:729–34.

    Article  Google Scholar 

  19. Howell DA, Sanders MK, Bernadino KP, et al. Randomized controlled trial of a new nitinol non-foreshortening self-expanding metal stent for malignant biliary obstruction: an international multi-center comparison in two diameters to Wallstent. Gastroenterology. 2006;130(Suppl. 2).

    Google Scholar 

  20. Isayama H, Kawabe T, Nakai Y, et al. Management of distal malignant biliary obstruction with the ComVi stent, a new covered metallic stent. Surg Endosc. 2010;24:131–137.

    Article  PubMed  Google Scholar 

  21. Pinol V, Castells A, Bordas JM. Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial. Radiology. 2002;225:27–34.

    Article  PubMed  Google Scholar 

  22. van Delden OM, Lameris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol. 2008;18:448–56.

    Article  PubMed  Google Scholar 

  23. Dahlstrand U, Sandblom G, Eriksson L-G, et al. Primary patency of percutaneously inserted self-expanding metallic stents in patients with malignant biliary obstruction. HPB (Oxford). 2009;11:358–63.

    Article  Google Scholar 

  24. Castano R, Lopes TL, Alvarez O, et al. Nitinol biliary stent versus surgery for palliation of distal malignant biliary obstruction. Surg Endosc. 2010;24:2092–8.

    Article  PubMed  Google Scholar 

  25. Ferreira LEC, Baron TH. Endoscopic stenting for palliation of a malignant biliary obstruction. Expert Rev Med Devices. 2010;7:681–91.

    Article  PubMed  CAS  Google Scholar 

  26. Ornellas LC, Stefanidis G, Chuttani R, et al. Covered Wallstents for palliation of malignant biliary obstruction: primary stent placement versus reintervention. Gastrointest Endosc. 2009;70:676–83.

    Article  PubMed  Google Scholar 

  27. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc. 2005;61:528–33.

    Article  PubMed  Google Scholar 

  28. Kubota Y, Mukai H, Nakaizumi A, et al. Covered Wallstent for palliation of malignant common bile duct stricture: prospective multicenter evaluation. Dig Endosc. 2005;17:218–23.

    Article  Google Scholar 

  29. Isayama H, Komatsu Y, Tsujino T, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002;55:366–70.

    Article  PubMed  Google Scholar 

  30. Kim HS, Lee DK, Kim HG, et al. Features of ­malignant biliary obstruction affecting the patency of metallic stents: a multicenter study. Gastrointest Endosc. 2002;55:359–65.

    Article  PubMed  Google Scholar 

  31. Bueno JT, Gerdes H, Kurtz RC. Endoscopic management of occluded biliary Wallstents: a cancer center experience. Gastrointest Endosc. 2003;58:879–84.

    Article  PubMed  Google Scholar 

  32. Ridtitid W, Rerknimitr R, Janchai A, et al. Outcome of second interventions for occluded metallic stents in patients with malignant biliary obstruction. Surg Endosc. 2010;24:2216–20.

    Article  PubMed  Google Scholar 

  33. Cho JH, Jeon TJ, Park JY, et al. Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. Surg Endosc. 2011;25:475–82.

    Article  PubMed  Google Scholar 

  34. Katsinelos P, Beltsis A, Chatzimavroudis G, et al. Endoscopic management of occluded biliary uncovered metal stents: a multicenter experience. World J Gastroenterol. 2011;7:98–104.

    Article  Google Scholar 

  35. Yoon WJ, Ryu JK, Lee JW, et al. Endoscopic management of occluded metal biliary stents: Metal versus 10F plastic stents. World J Gastroenterol. 2010;14: 5347–52.

    Article  Google Scholar 

  36. Nakai Y, Isayama H, Komatsu Y, et al. Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005;62:742–8.

    Article  PubMed  Google Scholar 

  37. Artifon EL, Sakai P, Ishioka S, et al. Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate; a prospective randomized control trial. J Clin Gastroenterol. 2008;42:815–9.

    Article  PubMed  Google Scholar 

  38. Smith AG, Dowset JF, Rassell RCG, et al. Randomized trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet. 1994;344:1655–60.

    Article  PubMed  CAS  Google Scholar 

  39. Anderson JR, Sonsen SM, Kruse A, et al. Randomized trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30:1132–5.

    Article  Google Scholar 

  40. Davids PHP, Groen AK, Rauws EAJ, et al. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.

    Article  PubMed  CAS  Google Scholar 

  41. Knyrim K, Wagner HJ, Pausch J, et al. 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 

  42. Ainley CC, Williams SJ, Smith AC, et al. Gallbladder sepsis after stent insertion for bile duct obstruction: management by percutaneous cholecystectomy. Br J Surg. 1991;78:961–3.

    Article  PubMed  CAS  Google Scholar 

  43. Saito H, Sakurai Y, Takamura A, et al. Biliary endoprosthesis using Gore-Tex covered expandable metallic stents: preliminary clinical evaluation [in Japanese with English abstract]. Nippon Acta Radiologica. 1994;54:180–2.

    CAS  Google Scholar 

  44. Kawase Y, Motoyama A, Kawanishi M, et al. Experience with Strecker stent covered with polyurethane membrane for malignant biliary strictures [in Japanese with English abstract]. Gastroenterol Endosc. 1995;37:1229–35.

    Google Scholar 

  45. Miyayama S, Matsui O, Terayama N, et al. Covered Gianturco Stent for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol. 1997;8:641–8.

    Article  PubMed  CAS  Google Scholar 

  46. Shim CS, Lee YH, Cho YD, et al. Preliminary results of a new covered biliary metal stent for malignant biliary obstruction. Endoscopy. 1998;30:345–50.

    Article  PubMed  CAS  Google Scholar 

  47. Bezzi M, Zolovkins A, Cantisani V, et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol. 2002;13:581–9.

    Article  PubMed  Google Scholar 

  48. Schoder M, Rossi P, Uflacker R, et al. Malignant biliary obstruction: treatment with ePTFE-FEP-covered endoprostheses initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225:35–42.

    Article  PubMed  Google Scholar 

  49. Fumex F, Coumaro D, Napoleon B, et al. Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy. 2006;38:787–92.

    Article  PubMed  CAS  Google Scholar 

  50. Suk KT, Kim HS, Baik SK, et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc. 2006;64:522–9.

    Article  PubMed  Google Scholar 

  51. Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol. 2006;4:1148–53.

    Article  PubMed  Google Scholar 

  52. Cote GA, Kumar N, Ansstas M, et al. Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents. Gastrointest Endosc. 2010;72:748–54.

    Article  PubMed  Google Scholar 

  53. Han YH, Kim M-Y, Kim SY, et al. Percutaneous insertion of Zilver stent in malignant biliary obstruction. Abdom Imaging. 2006;31:433–8.

    Article  PubMed  CAS  Google Scholar 

  54. Bakhru M, Ho HC, Wang AY, et al. Fully covered self expandable metal stents in malignant biliary strictures: mid-term evaluation. J Gastroenterol Hepatol. 2011;26:1022–7.

    Article  PubMed  Google Scholar 

  55. Nicholson AA, Royston CMS. Palliation of inoperable biliary obstruction with self-expanding metallic endoprostheses: a review of 77 patients. Clin Radiol. 1993;47:245–50.

    Article  PubMed  CAS  Google Scholar 

  56. Stoker J, Lameris JS, Jeekel J. Percutaneously placed Wallstent endoprosthesis in patients with malignant distal biliary obstruction. Br J Surg. 1993;80:1185–7.

    Article  PubMed  CAS  Google Scholar 

  57. Boguth L, Tatalovic S, Antonucci F, et al. Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metallic prostheses. Radiology. 1994;192:669–74.

    PubMed  CAS  Google Scholar 

  58. Stocker J, Lameris JS. Complications of percutaneously inserted biliary Wallstent. J Vasc Interv Radiol. 1993;4:767–72.

    Article  Google Scholar 

  59. Hatzidakis AA, Tsetis D, Chrysou E, et al. Nitinol stents for palliative treatment of malignant obstructive jaundice: should we stent the sphincter of Oddi in every case? Cardiovasc Intervent Radiol. 2001;24:245–8.

    Article  PubMed  CAS  Google Scholar 

  60. Okamoto T, Fujioka S, Yanagisawa S, et al. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis. Gastrointest Endosc. 2006;63:792–6.

    Article  PubMed  Google Scholar 

  61. Misra SP, Dwivedi M. Reflux of duodenal contents and cholangitis in patients undergoing self-expanding metal stent placement. Gastrointest Endosc. 2009;70:317–21.

    Article  PubMed  Google Scholar 

  62. Thumbe VK, Houghton AD, Smith MS. Duodenal perforation by a Wallstent. Endoscopy. 2000;32:512–5.

    Article  Google Scholar 

  63. Vanbiervliet G, Piche T, Caroli-Bosc FX, et al. Endoscopic argon plasma trimming of biliary and gastrointestinal metallic stents. Endoscopy. 2005;37:434–8.

    Article  PubMed  CAS  Google Scholar 

  64. Chen YK, Jakribettuu V, Springer EW, et al. Safety and efficacy of argon plasma coagulation trimming of malpositioned and migrated biliary metal stents: a controlled study in the porcine model. Am J Gastroenterol. 2006;101:1–6.

    Article  Google Scholar 

  65. Moon SK, Cheung DY, Kim JH, et al. A case of choledochoduodenal fistula as a delayed complication after biliary metallic stent placement in distal cholangiocarcinoma. Korean J Gastroenterol. 2008;51:314–8.

    PubMed  Google Scholar 

  66. Rasmussen IC, Dahlstrand U, Sandblom G, et al. Fractures of self-expanding metallic stents in periampullary malignant biliary obstruction. Acta Radiol. 2009;23:730–7.

    Article  Google Scholar 

  67. Peck R, Wattam J. Fracture of Memotherm metallic stents in the biliary tract. Cardiovasc Intervent Radiol. 2000;23:55–6.

    Article  PubMed  CAS  Google Scholar 

  68. van der Gaag NA, Rauws EAJ, van Eijck CHJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–37.

    Article  PubMed  Google Scholar 

  69. Mullen JT, Lee JH, Gomez HF, et al. Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg. 2005;9:1094–104.

    Article  PubMed  Google Scholar 

  70. Decker C, Christein JD, Phadnis MA, et al. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer. Surg Endosc. 2011;25:2364–7.

    Article  PubMed  Google Scholar 

  71. Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2008;3:CD005444.

    PubMed  Google Scholar 

  72. Kahaleh M, Brock A, Conaway MR, et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability; a new concept validated by a decision analysis. Endoscopy. 2007;39:319–24.

    Article  PubMed  CAS  Google Scholar 

  73. Baron TH. Management of simultaneous biliary and duodenal obstruction: the endoscopic perspective. Gut Liver. 2010;4(Suppl. 1):S50–6.

    Article  PubMed  Google Scholar 

  74. Burmester E, Niehaus J, Leineweber T, et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003;57:246–51.

    Article  PubMed  Google Scholar 

  75. Kahaleh M, Hernandez AJ, Tokar J, et al. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006;64:52–9.

    Article  PubMed  Google Scholar 

  76. Itoi T, Itokawa F, Sofuni A, et al. Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2008;14:6078–82.

    Article  PubMed  Google Scholar 

  77. Yamao K, Bhatia V, Mizuno N, et al. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy. 2008;40:340–2.

    Article  PubMed  CAS  Google Scholar 

  78. Itoi T, Yamao K. EUS 2008 Working Group document: evaluation of EUS-guided choledochoduodenostomy (with video). Gastrointest Endosc. 2009;69:S8–12.

    Article  PubMed  Google Scholar 

  79. Siddiqui AA, Sreenarasimhaiah J, Lara LF, et al. Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction. Surg Endosc. 2011;25:549–55.

    Article  PubMed  Google Scholar 

  80. Park DH, Koo JE, Oh J, et al. EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study. Am J Gastroenterol. 2009;104:2168–74.

    Article  Google Scholar 

  81. Nguyen-Tang T, Binmoeller KF, Shah JN. Endoscopic ultrasound-guided transhepatic antegrade self-­expandable metal stent placement across malignant biliary obstruction. Endoscopy. 2010;42:232–6.

    Article  PubMed  CAS  Google Scholar 

  82. Moon JH, Choi HJ, Ko BM, et al. Combined endoscopic stent-in-stent placement for malignant and duodenal obstruction by using a new duodenal metal stent (with video). Gastrointest Endosc. 2009;70:772–7.

    Article  PubMed  Google Scholar 

  83. Hu B, Wang T-T, Shi Z-M, et al. A novel antireflux metal stent for the palliation of biliary malignancies: a pilot feasibility study (with video). Gastrointest Endosc. 2011;73:143–148.

    Article  PubMed  Google Scholar 

  84. Lee DK, Kim HS, Kim K-S, et al. The effect on porcine bile duct of a metallic stent covered with a paclitaxel-incorporated membrane. Gastrointest Endosc. 2005;61:296–301.

    Article  PubMed  Google Scholar 

  85. Suk KT, Kim JW, Kim HS, et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc. 2007;66:798–803.

    Article  PubMed  Google Scholar 

  86. Song TJ, Lee SS, Yun SC, et al. Paclitaxel-eluting covered metal stents versus covered metal stents for distal malignant biliary obstruction: a prospective competitive pilot study. Gastrointest Endosc. 2011;73:727–33.

    Article  PubMed  Google Scholar 

  87. Lee DK. Drug-eluting stent in malignant biliary obstruction. J Hepatobiliary Pancreat Surg. 2009;16:628–32.

    Article  PubMed  Google Scholar 

  88. Baron TH. Endoscopic retrograde cholangiopancreatography (DDW highlight). Endoscopy. 2010;42:938–43.

    Article  PubMed  CAS  Google Scholar 

Further Reading

  1. Kaasis M, Boyer J, Dumas 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  Google Scholar 

  2. Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–9.

    PubMed  CAS  Google Scholar 

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  1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, 712 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea

    Dong Ki Lee M.D., Ph.D.

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  1. Dong Ki Lee M.D., Ph.D.
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Correspondence to Dong Ki Lee M.D., Ph.D. .

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Editors and Affiliations

  1. , Virginia Mason Medical Center, Digestive Disease Institute, 1100 Ninth Ave, Seattle, 98111, Washington, USA

    Richard Kozarek

  2. , Division of Gastroenterology and Hepatol, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, 55905, Minnesota, USA

    Todd Baron

  3. , Department of Radiology, Asan Medical Center, Pungnap-2Dong 388-1, Seoul, 138-736, Korea, Republic of (South Korea)

    Ho-Young Song

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Lee, D.K. (2013). Biliary Malignancy: Distal. In: Kozarek, R., Baron, T., Song, HY. (eds) Self-Expandable Stents in the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3746-8_16

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