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Partially covered self-expanding metal stent for unresectable malignant extrahepatic biliary obstruction: results of a large prospective series

Surgical Endoscopy volume 26, pages 222–229 (2012)Cite this article

Abstract

Background

Endoscopic biliary stenting is a well-established palliative treatment in patients with unresectable malignant biliary strictures. Obstruction of uncovered self-expanding metal stent (SEMS) due to tumor ingrowth is the most frequent complication. Partially covered SEMS might increase stent patency but could favor complications related to stent covering, such as pancreatitis, cholecystitis, and migration. The aim of this study was to evaluate the efficacy and safety of partially covered SEMS in patients with an unresectable malignant biliary stricture.

Methods

Patients with malignant extrahepatic biliary obstruction treated endoscopically with partially covered SEMS were included in this multicenter, prospective, nonrandomized study.

Results

One hundred ninety-nine patients were endoscopically treated with partially covered SEMS in 32 Spanish hospitals. Clinical success after deep cannulation was 96%. Early complications occurred in 4% (3 pancreatitis, 2 cholangitis, 1 hemorrhage, 1 perforation, and 1 cholecystitis). Late complications occurred in 19.5% (18 obstructions, 10 migrations, 6 cholangitis without obstruction, 3 acute cholecystitis, and 2 pancreatitis), with no tumor ingrowth in any case. Median stent patency was 138.9 ± 112.6 days. One-year actuarial probability of stent patency was 70% and that of nonmigration was 86%. Multivariate analysis showed adjuvant radio- or chemotherapy as the only independent predictive factor of stent patency and previous insertion of a biliary stent was the only predictive factor of migration.

Conclusions

The partially covered SEMS was easily inserted, had a high clinical success rate, and prevented tumor ingrowth. The incidence of possible complications related to stent coverage, namely, migration, pancreatitis, and cholecystitis, was lower than in previously published series.

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Acknowledgements

This multicenter study was performed by the Collaborating Group of the COBIWA Register. In addition to the authors, the following investigators participated in this study (all institutions are in Spain): José Luis Vazquez, MD, PhD, Hospital Juan Canalejo, A Coruña; Agustí Panadès, MD, Hospital del Mar, Barcelona; Francesc Vida, MD, Fundació Althaia, Manresa; Cándido Villanueva, MD, PhD, Hospital Santa Creu i Sant Pau, Barcelona; Enric Brullet, MD, PhD, and Rafael Campo, MD, PhD, Hospital Parc Taulí, Sabadell; Albert Tomas, MD, PhD, Hospital General de Catalunya, Barcelona; Jorge Espinós, MD, Mútua de Terrassa, Terrassa; Alfredo Juan López, MD, and Luis Yuguero, MD, Hospital General Yagüe, Burgos; Leopoldo Martin, MD, Hospital Universitario Puerta del Mar, Cádiz; Francisco Romper, MD, Hospital Alarcos, Ciudad Real; Gregorio Urdapilleta, MD, Donostia Ospitalea, Guipúzcoa; Oscar Roncero García-Escribano, MD, Hospital La Mancha Centro, Ciudad Real; Juan Francisco De Dios, MD, and Antonio Naranjo, MD, Hospital Universitario Reina Sofía, Córdoba; Jesús Garcia-Cano, MD, Virgen de la Luz, Cuenca; José Luis Cervantes, MD, Complejo Hospitalario San Millán- San Pedro, La Rioja; Jesús Espinel, MD, Hospital de León, León; Leopoldo López, MD, Xeral, Lugo; Miguel Muñoz, MD, Clínica Universitaria de Navarra, Pamplona; Javier Eguaras, MD, Hospital Virgen del Camino, Navarra; Javier Barnecilla, MD, Rio Carrion, Palencia; Antonio Rodríguez, MD, Hospital Universitario de Salamanca, Salamanca; Felipe Martinez, MD, Clínica Santa Isabel, Sevilla; Vicente Sanchiz, MD, Hospital Clinico Universitario de Valencia, Valencia; Vicente Pons, MD, Hospital La Fe, Valencia; Antonio López, MD, Hospital Universitario Dr. Peset, Valencia; Manuel Perez, MD, Hospital Universitario Río Ortega, Valladolid; Victor Manuel Orive, MD, Hospital Basurto, Vizcaya; Carlos de la Serna, MD, and Santiago Jose Rodríguez, MD, Hospital Virgen de la Concha, Zamora.

Conflicts of interest

None.

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Affiliations

  1. Endoscopy Unit, Service of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08041, Barcelona, Spain

    Cristina Gómez-Oliva, Carlos Guarner-Argente, Mar Concepción & Carlos Guarner Aguilar

  2. Endoscopy Unit, Service of Gastroenterology, Hospital de Navarra, Pamplona, Spain

    Francisco Javier Jiménez

  3. Endoscopy Unit, Service of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain

    Sarbelio Rodrίguez

  4. Endoscopy Unit, Service of Gastroenterology, Hospital Universitari Dr. Josep Trueta, Girona, Spain

    Ferran Gonzalez-Huix

  5. Endoscopy Unit, Service of Gastroenterology, Hospital Donostia Ospitalea, Guipuzcoa, Spain

    Fernando Mugica

  6. Endoscopy Unit, Service of Gastroenterology, Hospital Galdakao, Vizcaya, Spain

    José Luis Cabriada

  7. Endoscopy Unit, Service of Gastroenterology, Hospital Universitario Puerta del Mar, Cadiz, Spain

    Claudio Rodríguez

Authors
  1. Cristina Gómez-Oliva
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  2. Carlos Guarner-Argente
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  3. Mar Concepción
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  4. Francisco Javier Jiménez
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  5. Sarbelio Rodrίguez
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  6. Ferran Gonzalez-Huix
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  7. Fernando Mugica
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  8. José Luis Cabriada
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  9. Claudio Rodríguez
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  10. Carlos Guarner Aguilar
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Consortia

Collaborating Group of the COBIWA Register

Corresponding author

Correspondence to Cristina Gómez-Oliva.

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Gómez-Oliva, C., Guarner-Argente, C., Concepción, M. et al. Partially covered self-expanding metal stent for unresectable malignant extrahepatic biliary obstruction: results of a large prospective series. Surg Endosc 26, 222–229 (2012). https://doi.org/10.1007/s00464-011-1858-z

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Keywords

  • Pancreatobiliary
  • Cholangiopancreatography (ERCP)
  • Cancer digestive
  • Stenting
  • Therapeutic
  • Palliation