Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 2088–2092 | Cite as

Biliary Stenting in Patients with Malignant Biliary Obstruction: Comparison of Double Layer, Plastic and Metal Stents

  • Saleh Elwir
  • Kaveh Sharzehi
  • Joshua Veith
  • Mathew T. Moyer
  • Charles Dye
  • Thomas McGarrity
  • Abraham Mathew
Original Article

Abstract

Background and Aim

The double layer stent (DLS) has a unique design and has been used for palliation of malignant biliary obstruction, but literature on this stent is limited. Our aim was to compare plastic (PS), DLS and metal stents (MS) in terms of complication rates, time to occlusion, and patency rate in patients with malignant biliary obstruction (MBO).

Methods

A retrospective review of stents placed for MBO at our institution in the period between January 2009 and April 2011 was conducted. A total of 114 stents were identified, of which 44 were MS (39 %), 37 DLS (32 %), and 33 PS (29 %). A stent was considered occluded when an unplanned stent removal or intervention occurred due to clinical suspicion of biliary obstruction.

Results

Stents remained patent for 95 days (range 7–359 days) in the DLS group and 59 days (range 7–228 days) in the PS group (P = 0.014) and 128.7 days (range 4–602 days) in the metal stent group. Twenty-seven percent (n = 9) of PS occluded after a mean of 60 days while 16 % (n = 7) of MS occluded after a mean of 87 days and 5 % (n = 2) of DLS occluded after a mean of 85 days (DLS vs. PS P = 0.012, DLS vs. MS P = 0.13, MS vs. PS P = 0.22).

Conclusions

DLS are superior to PS in patients with MBO and appear to be comparable to MS. MS had a longer patency rate but were comparable to DLS in early and late complications. We speculate that the less expensive DLS may be a cost effective alternative in the palliation of MBO.

Keywords

Double layer stents Malignant biliary obstruction ERCP 

References

  1. 1.
    Adler DG, Baron TH, Davila RE, et al. Asge guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62:1–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Ferreira LE, Baron TH. Endoscopic stenting for palliation of malignant biliary obstruction. Expert Rev Med Devices. 2010;7:681–691.PubMedCrossRefGoogle Scholar
  3. 3.
    Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 2006;CD004200.Google Scholar
  4. 4.
    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;33:213–221.PubMedCrossRefGoogle Scholar
  5. 5.
    Donelli G, Guaglianone E, Di Rosa R, Fiocca F, Basoli A. Plastic biliary stent occlusion: factors involved and possible preventive approaches. Clin Med Res. 2007;5:53–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Jaganmohan S, Lee JH. Self-expandable metal stents in malignant biliary obstruction. Expert Rev Gastroenterol Hepatol. 2012;6:105–114.PubMedCrossRefGoogle Scholar
  7. 7.
    van Berkel AM, van Marle J, Groen AK, Bruno MJ. Mechanisms of biliary stent clogging: confocal laser scanning and scanning electron microscopy. Endoscopy. 2005;37:729–734.PubMedCrossRefGoogle Scholar
  8. 8.
    Uno K, Yasuda K, Tanaka K, Hayakumo T, Nakajima M. Evaluation of new plastic stents for malignant biliary obstruction. Dig Endosc. 2001;13:159–162.CrossRefGoogle Scholar
  9. 9.
    Tringali A, Mutignani M, Perri V, et al. A prospective, randomized multicenter trial comparing doublelayer and polyethylene stents for malignant distal common bile duct strictures. Endoscopy. 2003;35:992–997.PubMedCrossRefGoogle Scholar
  10. 10.
    Isayama H, Yasuda I, Ryozawa S, et al. Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (jm-test): covered wallstent versus doublelayer stent. Dig Endosc. 2011;23:310–315.PubMedCrossRefGoogle Scholar
  11. 11.
    Katsinelos P, Paroutoglou G, Chatzimavroudis G, et al. Prospective randomized study comparing double layer and Tannenbaum stents in distal malignant biliary stenosis. Acta Gastroenterol Belg. 2010;73:445–450.PubMedGoogle Scholar
  12. 12.
    Nakamura S, Ohara H, Yamada T, et al. Efficacy of plastic tube stents without side holes for middle and lower biliary strictures. J Clin Gastroenterol. 2002;34:77–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Takasawa O, Fujita N, Kobayashi G, Noda Y, Ito K, Horaguchi J. Endoscopic biliary drainage for patients with unresectable pancreatic cancer with obstructive jaundice who are to undergo gemcitabine chemotherapy. World J Gastroenterol. 2006;12:7299–7303.PubMedGoogle Scholar
  14. 14.
    Seitz U, Vadeyar H, Soehendra N. Prolonged patency with a new-design Teflon biliary prosthesis. Endoscopy. 1994;26:478–482.PubMedCrossRefGoogle Scholar
  15. 15.
    Binmoeller KF, Seitz U, Seifert H, Thonke F, Sikka S, Soehendra N. The Tannenbaum stent: a new plastic biliary stent without side holes. Am J Gastroenterol. 1995;90:1764–1768.PubMedGoogle Scholar
  16. 16.
    Terruzzi V, Comin U, De Grazia F, et al. Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis. Gastrointest Endosc. 2000;51:23–27.PubMedCrossRefGoogle Scholar
  17. 17.
    Carolyn C, Thompson CC, Werkman R, Mcgarrity TJ, Mathew A. Outcome of double layer biliary stents and self expanding metal stents in the palliation of malignant biliary obstruction: a retrospective comparison. Gsatrointestinal Endoscopy. 2002;55:AB153.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Saleh Elwir
    • 1
  • Kaveh Sharzehi
    • 2
  • Joshua Veith
    • 3
  • Mathew T. Moyer
    • 4
  • Charles Dye
    • 4
  • Thomas McGarrity
    • 4
  • Abraham Mathew
    • 4
  1. 1.Department of Internal MedicinePenn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA
  2. 2.Fox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Penn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA
  4. 4.Division of Gastroenterology and HepatologyPenn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA

Personalised recommendations