Abstract
To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9±4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gillams A, Dick R, Dooley JS, Wallsten H, El-Dim A (1990) Self-expandable stainless steel braided endoprostheses for biliary strictures. Radiology 174:137–140
Kaskarelis IS, Papadaki MG, Papageorgiou GN, Limniati MD, Malliaraki NE, Piperopoulos PN (1999) Long-term follow-up in patients with malignant biliary obstruction after percutaneous placement of uncovered Wallstent endoprostheses. Acta Radiol 40:528–533
Tesdal IK, Adamus R, Poeckler C, Koepke J, Jaschke W, Georgi M (1997) Therapy for biliary stenoses and occlusions with use of three different metallic stents: single-center experience. J Vasc Interv Radiol 8:869–879
Lee BH, Choe DH, Lee JH, Kim KH, Chin SY (1997) Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR Am J Roentgenol 168:741–745
Thurnher SA, Lammer J, Thurnher MM, Wilkenbauer F, Graf O, Wildling R (1996) Covered self-expanding transhepatic biliary stents: clinical pilot study. Cardiovasc Intervent Radiol 19:10–14
Lammer J, Hausegger KA, Flückiger F et al (1996) Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 201:167–172
Shim CS, Lee JH, Cho JD et al (1998) Preliminary results of a new covered biliary metal stent for malignant biliary obstruction. Endoscopy 30:345–350
Rossi P, Bezzi M, Rossi M et al (1994) Metallic stents in malignant biliary obstruction: results of multicenter European study of 240 patients. J Vasc Interv Radiol 5:279–285
Gordon RL, Ring EJ, LaBerge JM, Doherty MM (1992) Malignant biliary obstruction: treatment with expandable metallic stents-follow-up of 50 consecutive patients. Radiology 182:697–701
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Dick BW, Gordon RL, La Berge JM, Doherty M, Ring EJ (1990) Percutaneous transhepatic placement of biliary endoprostheses: results in 100 consecutive patients. J Vasc Interv Radiol 1:97–100
Yasumori K, Mahmoudi N, Wright KC, Wallace S, Gianturco C (1993) Placement of covered self-expanding metallic stents in the common bile duct: a feasibility study. J Vasc Interv Radiol 4:773–778
Saito H, Sakurai Y, Takamura A, Horio K (1994) Biliary endoprosthesis using Gore-Tex covered expandable metallic stent: preliminary clinical evaluation. Nippon Igaku Hoshasen Gakkai Zasshi 54:180–182
Miyayama S, Matsui O, Terayama N, Tatsu H, Yamamoto T, Takashima T (1997) Covered Gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol 8:641–648
Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G (1997) Clinical experience with covered Wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol 20:441–447
Hausegger KA, Thurner S, Bodendorfer G et al (1998) Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol 170:403–408
Bezzi M, Zolovkins A, Cantisani V, Salvatori FM, Rossi M, Fanelli F, Rossi P (2002) New ePTFE /FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol 13(6):581–589, Jun
Kuo MD, Lopresti DC, Gover DD, Hall LD, Ferrara SL (2006) Intentional retrieval of Viabil stent-grafts from the biliary system. J Vasc Interv Radiol 17(2 Pt 1):389–397, Feb
Schoder M, Rossi P, Uflacker R, Bezzi M, Stadler A, Funovics MA, Cejna M, Lammer J (2002) Malignant biliary obstruction: treatment with ePTFE /FEP-covered endoprotheses-initial technical and clinical experience in a multicenter trial. Radiology 225:35–42
Hatzidakis A, Krokidis M, Kalbakis K, Romanos J, Petrakis I, Gourtsoyiannis N (2007) ePTFE /FEP-covered metallic stents for palliation of malignant biliary disease: can tumor ingrowth be prevented? Cardiovasc Interv Radiol 30(5):950–958
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fanelli, F., Orgera, G., Bezzi, M. et al. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience. Eur Radiol 18, 911–919 (2008). https://doi.org/10.1007/s00330-008-0852-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-008-0852-x