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Efficacy and safety of covered self-expandable metal stents for management of distal malignant biliary obstruction due to lymph node metastases

Surgical Endoscopy volume 25, Article number: 3094 (2011) Cite this article

Abstract

Background

Distal malignant biliary obstruction (MBO) due to lymph node metastases (LNM) is a common problem in advanced malignant disease. However, the role of covered self-expandable metal stents (SEMS) in treating MBO has not been studied. The aim of this study was to evaluate the efficacy and safety of covered SEMS for the treatment of distal MBO due to LNM.

Methods

Between November 1994 and December 2009, a total of 65 patients with distal MBO due to LNM underwent covered (n = 44) and uncovered (n = 21) SEMS placement.

Results

Successful drainage was achieved in all patients. There was no significant difference in patient survival. The cumulative stent patency of covered SEMS was significantly higher than that of uncovered SEMS (P = 0.0020). Stent occlusion occurred in 5 patients (11%) with covered SEMS and in 8 (38%) with uncovered SEMS. There was no tumor ingrowth in covered SEMS, but seven in the uncovered SEMS group showed some ingrowth. Cholecystitis was not observed, but mild pancreatitis was observed in 6 (14%) of those with covered SEMS. No stent-insertion-related deaths occurred.

Conclusions

Covered SEMS are safe and effective for treatment of distal malignant biliary obstruction due to LNM.

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Acknowledgments

The authors are grateful to Drs. R. Nakata, Y. Maruyama, K. Tagawa, M. Taniguchi, T. Katamoto, and T. Kawase for their assistance.

Disclosures

Drs. Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Osamu Togawa, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Saburo Matsubara, Natsuyo Yamamoto, Kenji Hirano, Takeshi Tsujino, Nobuo Toda, Minoru Tada, Masao Omata, and Kazuhiko Koike have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kazumichi Kawakubo, Hiroyuki Isayama, Yousuke Nakai, Naoki Sasahira, Hirofumi Kogure, Takashi Sasaki, Natsuyo Yamamoto, Kenji Hirano, Minoru Tada, Masao Omata & Kazuhiko Koike

  2. Department of Gastroenterology, JR Tokyo General Hospital, Shibuya-ku, Tokyo, Japan

    Osamu Togawa

  3. Department of Gastroenterology, Kanto Central Hospital, Setagaya-ku, Tokyo, Japan

    Saburo Matsubara

  4. Department of Gastroenterology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan

    Takeshi Tsujino

  5. Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan

    Nobuo Toda

  6. Yamanashi Prefectural Hospital Organization, Kofu, Yamanashi, Japan

    Masao Omata

Authors
  1. Kazumichi Kawakubo
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  2. Hiroyuki Isayama
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  3. Yousuke Nakai
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  4. Osamu Togawa
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  5. Naoki Sasahira
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  6. Hirofumi Kogure
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  7. Takashi Sasaki
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  8. Saburo Matsubara
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  9. Natsuyo Yamamoto
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  10. Kenji Hirano
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  11. Takeshi Tsujino
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  12. Nobuo Toda
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  13. Minoru Tada
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  14. Masao Omata
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  15. Kazuhiko Koike
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Corresponding author

Correspondence to Hiroyuki Isayama.

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Kawakubo, K., Isayama, H., Nakai, Y. et al. Efficacy and safety of covered self-expandable metal stents for management of distal malignant biliary obstruction due to lymph node metastases. Surg Endosc 25, 3094 (2011). https://doi.org/10.1007/s00464-011-1675-4

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  • DOI: https://doi.org/10.1007/s00464-011-1675-4

Keywords

  • Metallic stent
  • Covered metallic stent
  • Malignant biliary obstruction
  • Metastatic lymph node