Medical Oncology

, Volume 29, Issue 4, pp 2762–2770 | Cite as

Covered stents versus uncovered stents for the palliation of malignant extrahepatic biliary obstruction caused by direct tumor invasion: a cohort comparative study

  • Feng Li
  • Feng Wang
  • Xinshun Yang
  • Donghua Ji
  • Jun Li
  • Ningfang Wang
  • Yongsheng Liu
  • Cheng Li
  • Tao Zhang
  • Ke Li
Original Paper


Biliary stenting is a well-established palliative treatment in patients with unresectable malignant biliary strictures. The aim of the present study was to compare clinical outcomes of covered and uncovered stents in patients with malignant extrahepatic biliary obstruction caused by direct tumor invasion. Patients diagnosed with malignant extrahepatic biliary obstruction caused by direct tumor invasion were enrolled in this study. Of these patients, 37 received ePTFE-covered stent placement and were prospectively studied, and 47 received uncovered stent placement and were retrospectively studied. The technical success rate, tumor ingrowth rate, complication rate, stent patency, and patient survival were evaluated for both groups. Stent placement was successful in all cases except one in the covered group due to stent kinking. Tumor ingrowth occurred exclusively in the uncovered group. No significant differences were observed for the complication rate and patient survival between the two groups. Three patients in the covered group experienced stent migration, whereas no patients did in the uncovered group. A significant difference was found regarding stent patency, which was greater for the covered group compared to the uncovered group. The placement of ePTFE-covered stents for the treatment of malignant biliary obstruction caused by direct tumor invasion was a safe and an effective method characterized by greater stent patency.


Biliary stenting Malignant biliary obstruction ePTFE-covered Metallic stent 


  1. 1.
    Michelassi F, Erroi F, Dawson PJ, et al. Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg. 1989;210:544–54.PubMedCrossRefGoogle Scholar
  2. 2.
    Stern N, Sturgess R. Endoscopic therapy in the management of malignant biliary obstruction. Eur J Surg Oncol. 2008;34:313–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Gandini R, Fabiano S, Pipitone V, et al. Management of biliary neoplastic obstruction with two different metallic stents implanted in one session. Cardiovasc Intervent Radiol. 2005;28:48–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Loew BJ, Howell DA, Sanders MK, et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc. 2009;70:445–53.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Krokidis M, Fanelli F, Orgera G, et al. Percutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents. Cardiovasc Intervent Radiol. 2011;34:352–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Han JK, Choi BI, Kim AY, et al. Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. Radiographics. 2002;22:173–87.PubMedGoogle Scholar
  12. 12.
    Kim MJ, Mitchell DG, Ito K, et al. Biliary dilatation: differentiation of benign from malignant causes—value of adding conventional MR imaging to MR cholangiopancreatography. Radiology. 2000;214:173–81.PubMedGoogle Scholar
  13. 13.
    Manfredi R, Masselli G, Maresca G, et al. MR imaging and MRCP of hilar cholangiocarcinoma. Abdom Imaging. 2003;28:319–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Park do H, Kim MH, Choi JS, et al. Covered versus uncovered Wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol. 2006;4:790–6.Google Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Katsinelos P, Kountouras J, Paroutoglou G, et al. Uncovered Hanaro versus Luminex metal stents for palliation of Malignant biliary strictures. J Clin Gastroenterol. 2008;42:539–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Gwon DI, Ko GY, Kim JH, et al. A comparative analysis of PTFE covered and uncovered stents for palliative treatment of malignant extrahepatic biliary obstruction. Am J Roentgenol. 2010;195:W463–9.CrossRefGoogle Scholar
  20. 20.
    Schoder M, Rossi P, Uflacker R, et al. Malignant biliary obstruction: treatment with PTFE-FEP covered endoprostheses: initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225:35–42.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Hatzidakis A, Krokidis M, Kalbakis K, et al. ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease: can tumor ingrowth be prevented? Cardiovasc Intervent Radiol. 2007;30:950–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Wang AY, Ellen K, Berg CL, et al. Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data—a case series. Endoscopy. 2009;41:781–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Fumex F, Coumaros 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.PubMedCrossRefGoogle Scholar
  25. 25.
    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;65:742–8.CrossRefGoogle Scholar
  26. 26.
    Togawa O, Kawabe T, Isayama H, et al. Management of occluded uncovered metallic stents in patients with malignant distal biliary obstructions using covered metallic stents. J Clin Gastroenterol. 2008;42:546–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Boguth L, Tatalovic S, Antonucci F, et al. Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology. 1994;192:669–74.PubMedGoogle Scholar
  28. 28.
    Carr-Locke DL. Metal stents for distal biliary malignancy: have we got you covered? Gastrointest Endosc. 2005;61:534–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Stoker J, Lameris JS. Complications of percutaneously inserted biliary Wallstents. J Vasc Interv Radiol. 1993;4:767–72.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    Stoker J, Lameris JS, Jeekel J. Percutaneously placed Wallstent endoprosthesis in patients with malignant distal biliary obstruction. Br J Surg. 1993;80:1185–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Nicholson AA, Royston CM. Palliation of inoperable biliary obstruction with self-expanding metal endoprostheses: a review of 77 patients. Clin Radiol. 1993;47:245–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Huibregtse K, Cheng J, Coene PP, et al. Endoscopic placement of expandable metal stents for biliary strictures: a preliminary report on experience with 33 patients. Endoscopy. 1989;21:280–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Feng Li
    • 1
  • Feng Wang
    • 1
  • Xinshun Yang
    • 1
  • Donghua Ji
    • 1
  • Jun Li
    • 1
  • Ningfang Wang
    • 1
  • Yongsheng Liu
    • 1
  • Cheng Li
    • 1
  • Tao Zhang
    • 1
  • Ke Li
    • 1
  1. 1.Department of Interventional TherapyFirst Affiliated Hospital of Dalian Medical UniversityDalianChina

Personalised recommendations