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Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents

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Abstract

Background

Duodenal covered self-expandable metal stent (cSEMS) can be used in malignant or benign gastroduodenal obstruction. The need for biliary stenting in patients with no concomitant biliary stricture, before duodenal cSEMS placement, remains unknown. The aim of this study was to determine whether cSEMS placement is responsible for biliary obstruction.

Methods

This is a single-center, retrospective, case-controlled study, including 106 patients with symptomatic gastric outlet obstruction or duodenal fistula who received a covered nitinol duodenal stent by using through-the-scope/over-the-wire placement procedure. The main outcome measurement was the occurrence comparison of jaundice and bilirubin level, between patients with previous or concomitant biliary stenting (cSEMS + BS group), and patients with no biliary stent (cSEMS group) during an observational period of 90 days.

Results

Hundred and six patients underwent cSEMS placement between June 2005 and March 2014: 53 in the cSEMS group (58 % male, mean age 66.4 ± 13.3 years) and 53 in cSEMS + BS group (60 % male, mean age 70.4 ± 11.6 years). The obstruction was due to cancer in 45 % in cSEMS group and 87 % in cSEMS + BS group. No case of jaundice was reported in the cSEMS group or in the cSEMS + BS group. In cSEMS group, the mean bilirubin level (μmol/L ± SD) was 8.0 ± 4 at baseline and 8.5 ± 4.6 at day 10, while in the cSEMS + BS group it was 91.4 ± 108 at baseline and 35.3 ± 39 at day 10 (p < 0.01). Patients from the two groups were matched on age, gender and bilirubin level at baseline. Evolution of bilirubinemia was +0.98 ± 2.76 µmol/L in experimental group and +0.39 ± 522 µmol/L in the control group (p = 0.34). No significant difference was observed between the two groups in term of technical success, clinical effectiveness, migration and other complications.

Conclusions

Previous biliary stenting is not required before endoscopic covered duodenal stent placement in patients with no associated biliary obstruction. Prospective studies are needed.

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References

  1. Maire F, Hammel P, Ponsot P, Aubert A, O’Toole D, Hentic O, Levy P, Ruszniewski P (2006) Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 101(4):735–742

    Article  PubMed  Google Scholar 

  2. Del Piano M, Ballaré M, Montino F, Todesco A, Orsello M, Magnani C, Garello E (2005) Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc 61(3):421–426

    Article  PubMed  Google Scholar 

  3. Chandrasegaram MD, Eslick GD, Mansfield CO, Liem H, Richardson M, Ahmed S, Cox MR (2012) Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction. Surg Endosc 26(2):323–329

    Article  PubMed  Google Scholar 

  4. Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, De Moura EG, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 44(1):37–43

    Article  CAS  PubMed  Google Scholar 

  5. Lee SM, Kang DH, Kim GH, Park WI, Kim HW, Park JH (2007) Self-expanding metallic stents for gastric outlet obstruction resulting from stomach cancer: a preliminary study with a newly designed double-layered pyloric stent. Gastrointest Endosc 66(6):1206–1210

    Article  PubMed  Google Scholar 

  6. Waidmann O, Trojan J, Friedrich-Rust M, Sarrazin C, Bechstein WO, Ulrich F, Zeuzem S, Albert JG (2013) SEMS vs cSEMS in duodenal and small bowel obstruction: high risk of migration in the covered stent group. World J Gastroenterol 19(37):6199–6206

    Article  PubMed Central  PubMed  Google Scholar 

  7. ASGE Standards of Practice Committee, Fukami N, Anderson MA, Khan K, Harrison ME, Appalaneni V, Ben-Menachem T, Decker GA, Fanelli RD, Fisher L, Ikenberry SO, Jain R, Jue TL, Krinsky ML, Maple JT, Sharaf RN, Dominitz JA (2011) The role of endoscopy in gastroduodenal obstruction and gastroparesis. Gastrointest Endosc 74(1):13–21

    Article  Google Scholar 

  8. Choi HJ, Lee BI, Kim JJ, Kim JH, Song JY, Ji JS, Kim BW, Choi H, Choi KY (2013) The temporary placement of covered self-expandable metal stents to seal various gastrointestinal leaks after surgery. Gut Liver 7(1):112–115

    Article  PubMed Central  PubMed  Google Scholar 

  9. Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97(1):72–78

    Article  PubMed  Google Scholar 

  10. Baron TH, Schöfl R, Puespoek A, Sakai Y (2001) Expandable metal stent placement for gastric outlet obstruction. Endoscopy 33(7):623–628

    CAS  PubMed  Google Scholar 

  11. Didden P, Spander MC, de Ridder R, Berk L, van Tilburg AJ, Leeuwenburgh I, Kuipers EJ, Bruno MJ (2013) Efficacy and safety of a partially covered stent in malignant gastric outlet obstruction: a prospective Western series. Gastrointest Endosc 77(4):664–668

    Article  PubMed  Google Scholar 

  12. Jung GS, Song HY, Kang SG, Huh JD, Park SJ, Koo JY, Cho YD (2000) Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 216(3):758–763

    Article  CAS  PubMed  Google Scholar 

  13. Yates MR 3rd, Morgan DE, Baron TH (1998) Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents. Endoscopy 30(3):266–272

    Article  PubMed  Google Scholar 

  14. Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD (2007) Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 8(7):18

    Article  Google Scholar 

  15. Kim SY, Song HY, Kim JH, Kim KR, Shin JH, Lee SS, Park SW (2008) Bridging across the ampulla of Vater with covered self-expanding metallic stents: is it contraindicated when treating malignant gastroduodenal obstruction? J Vasc Interv Radiol 19(11):1607–1613

    Article  PubMed  Google Scholar 

  16. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed Central  PubMed  Google Scholar 

  17. Choi WJ, Park JJ, Park J, Lim EH, Joo MK, Yun JW, Noh H, Kim SH, Choi WS, Lee BJ, Kim JH, Yeon JE, Kim JS, Byun KS, Bak YT (2013) Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis. Gut Liver 7(4):417–422

    Article  PubMed Central  PubMed  Google Scholar 

  18. Binkert CA, Jost R, Steiner A, Zollikofer CL (1996) Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses. Radiology 199(2):335–338

    Article  CAS  PubMed  Google Scholar 

  19. Dormann AJ, Deppe H, Wigginghaus B (2001) Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract - first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Z Gastroenterol 39(11):957–960

    Article  CAS  PubMed  Google Scholar 

  20. ASGE Standards of Practice Committee, Banerjee S, Cash BD, Dominitz JA, Baron TH, Anderson MA, Ben-Menachem T, Fisher L, Fukami N, Harrison ME, Ikenberry SO, Khan K, Krinsky ML, Maple J, Fanelli RD, Strohmeyer L (2010) The role of endoscopy in the management of patients with peptic ulcer disease. Gastrointes. Endosc. 71(4):663–668

    Article  Google Scholar 

  21. Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, Deniaud-Alexandre E, Ruszniewski P, Touboul E, Labianca R, de Gramont A, Louvet C (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25(3):326–331

    Article  CAS  PubMed  Google Scholar 

  22. Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36(6):543–550

    Article  CAS  PubMed  Google Scholar 

  23. Song HY, Shin JH, Yoon CJ, Lee GH, Kim TW, Lee SK, Yook JH, Kim BS (2004) A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 15(12):1443–1449

    Article  PubMed  Google Scholar 

  24. Yoon CJ, Song HY, Shin JH, Bae JI, Jung GS, Kichikawa K, Lopera JE, Castaneda-Zuniga W (2006) Malignant duodenal obstructions: palliative treatment using self-expandable nitinol stents. J Vasc Interv Radiol 17(2Pt1):319–326

    Article  PubMed  Google Scholar 

  25. Park DH, Jang JW, Lee SS, Seo DW, Lee SK, Kim MH (2011) EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 74(6):1276–1284

    Article  Google Scholar 

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Conflict of interest

All authors have no conflict of interest to declare.

Disclosures

L. Poincloux, F. Goutorbe, O. Rouquette, A. Mulliez, M. Goutte, G. Bommelaer, and A. Abergel have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France

    L. Poincloux, F. Goutorbe, O. Rouquette, G. Bommelaer & A. Abergel

  2. Biostatistics Unit, DRCI, Gabriel Montpied University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France

    A. Mulliez

  3. Clinical Research Unit, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France

    M. Goutte

  4. ISIT (Image Sciences for Innovations Techniques), UMR Auvergne University/CNRS 6284, Clermont-Ferrand, France

    L. Poincloux & A. Abergel

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  1. L. Poincloux
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  2. F. Goutorbe
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Correspondence to L. Poincloux.

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Poincloux, L., Goutorbe, F., Rouquette, O. et al. Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents. Surg Endosc 30, 437–445 (2016). https://doi.org/10.1007/s00464-015-4216-8

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  • DOI: https://doi.org/10.1007/s00464-015-4216-8

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