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Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness

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Abstract

Background

Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum) stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile duct obstruction.

Methods

In this study, 47 patients (median age, 73 years, range, 56–86 years) with inoperable malignant distal common bile duct strictures were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups. Cost-effectiveness analysis also was performed for the two study groups.

Results

The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001).

Conclusions

Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases and expected short survival time.

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References

  1. Shepherd HA, Royle G, Ross AP, Diba A, Arthur M, Colin-Jones D (1988) Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 75: 1166–1168

    PubMed  CAS  Google Scholar 

  2. Prat F, Chapat O, Ducot B, Ponchon T, Pelletier G, Fritsch J, Choury AD, Buffet C (1998) A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 47: 1–7

    Article  PubMed  CAS  Google Scholar 

  3. Lichtenstein DR, Carr-Locke DL (1995) Endoscopic palliation for unresectable pancreatic carcinoma. Surg Clin North Am 75: 969–988

    PubMed  CAS  Google Scholar 

  4. Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB (1994) Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 344: 1655–1660

    Article  PubMed  CAS  Google Scholar 

  5. Madoff DC, Wallace MJ (2002) Palliative treatment of unresectable bile duct cancer: which stent? Which approach? Surg Oncol Clin North Am 11: 923–939

    Article  Google Scholar 

  6. Pinol V, Castells A, Bordas JM, Real MI, Llach J, Montana X, Feu F, Navarro S (2002) Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial. Radiology 225: 27–34

    PubMed  Google Scholar 

  7. Eisen GM, Dominitz JA, Faigel DO, Goldstein JL, Kalloo AN, Petersen BT, Raddawi HM, Ryan ME, Vargo JJ III, Young HS, Fanelli RD, Hyman NH, Wheeler-Harbaugh J, American Society for Gastrointestinal Endoscopy. Standards of Practice Committee (2001) An annotated algorithmic approach to malignant biliary obstruction. Gastrointest Endosc 53: 849–852

    PubMed  CAS  Google Scholar 

  8. Van Steenbergen W (2001) Treatment of malignant biliary stenosis: which stent to use? Acta Gastroenterol Belg 64: 309–313

    PubMed  Google Scholar 

  9. Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB (2004) Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepatol 2: 273–285

    Article  PubMed  Google Scholar 

  10. Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, Canard JM, Fritsch J, Rey JF, Burtin P (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57: 178–182

    Article  PubMed  Google Scholar 

  11. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37: 383–393

    Article  PubMed  CAS  Google Scholar 

  12. Schilling D, Rink G, Arnold JC, Benz C, Adamek HE, Jakobs R, Riemann JF (2003) Prospective, randomized, single-center trial comparing 3 different 10F plastic stents in malignant mid and distal bile duct strictures. Gastrointest Endosc 58: 54–58

    Article  PubMed  Google Scholar 

  13. England RE, Martin DF, Morris J, Sheridan MB, Frost R, Freeman A, Lawrie B, Deakin M, Fraser I, Smith K (2000) A prospective randomised multicentre trial comparing 10-Fr Teflon Tannenbaum stents with 10-Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. Gut 46: 395–400

    Article  PubMed  CAS  Google Scholar 

  14. Chan FKL, Suen M, Li JYW, Sung JJY (1998) Bile immunoglobulins and blockage of biliary endoprosthesis: an immunohistochemical study. Biomed Pharmacother 52: 403–407

    Article  PubMed  CAS  Google Scholar 

  15. Leung JW, Ling TK, Kung JL, Vallance-Owen J (1988) The role of bacteria in the blockage of biliary stents. Gastrointest Endosc 34: 19–22

    PubMed  CAS  Google Scholar 

  16. Dowidar N, Kolmos HJ, Matzen P (1992) Experimental clogging of biliary endoprostheses: role of bacteria, endoprosthesis material, and design. Scand J Gastroenterol 27: 77–80

    PubMed  CAS  Google Scholar 

  17. Jansen B, Goodman LP, Ruiten D (1993) Bacterial adherence to hydrophilic polymer-coated polyurethane stents. Gastrointest Endosc 39: 670–673

    Article  PubMed  CAS  Google Scholar 

  18. Sung JY, Olson ME, Leung JWC, Lundberg MS, Costerton JW (1990) The sphincter of Oddi is a boundary for bacterial colonization in the feline biliary tract. Micro Ecology Health Dis 3: 199–208

    Article  Google Scholar 

  19. Amati L, Caradonna L, Greco B, Leo S, Caccavo D, Jirillo E (1998) Impairment of phagocytic and T-cell-mediated antibacterial activity and plasma endotoxins in patients with untreated gastrointestinal cancer. Scand J Gastroenterol 33: 847–852

    Article  PubMed  CAS  Google Scholar 

  20. Sung JJ, Sollano JD, Lai CW, Ismael A, Yung MY, Tumala I, Chung SC (1999) Long-term ciprofloxacin treatment for the prevention of biliary stent blockage: a prospective randomized study. Am J Gastroenterol 94: 3197–3201

    Article  PubMed  CAS  Google Scholar 

  21. Halm U, Schiefke, Fleig WE, Mossner J, Keim V (2001) Ofloxacin and ursodeoxycholic acid versus ursodeoxycholic acid alone to prevent occlusion of biliary stents: a prospective, randomized trial. Endoscopy 33: 491–494

    Article  PubMed  CAS  Google Scholar 

  22. Galandi D, Schwarzer G, Bassler D, Allgaier HP (2002) Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. Cochrane Database Syst Rev 3:CD003043

    PubMed  Google Scholar 

  23. Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S (2002) Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis. Gastrointest Endosc 56: 885–889

    Article  PubMed  Google Scholar 

  24. Ahuja V, Garg PK, Kumar D, Goindi G, Tandon RK (2002) Presence of white bile associated with lower survival in malignant biliary obstruction. Gastrointest Endosc 55: 186–191

    Article  PubMed  Google Scholar 

  25. Wagner HJ, Knyrim K, Vakil N, Klose KJ (1993) Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction: a prospective and randomized trial. Endoscopy 25: 213–218

    PubMed  CAS  Google Scholar 

  26. Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, Nakai Y, Yamamoto N, Tada M, Yoshida H, Shiratori Y, Kawabe T, Omata M (2004) A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 53: 729–734

    Article  PubMed  CAS  Google Scholar 

  27. Knyrim K, Wagner HJ, Pausch J, Vakil N (1993) A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 25: 207–212

    PubMed  CAS  Google Scholar 

  28. Moesch C, Sautereau D, Cessot F, Berry P, Mounier M, Gainant A, Pillegand B (1991) Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses. Hepatology 14: 1142–1146

    Article  PubMed  CAS  Google Scholar 

  29. Shah RJ, Howell DA, Desilets DJ, Sheth SG, Parsons WG, Okolo P III, Lehman GA, Sherman S, Baillie J, Branch MS, Pleskow D, Chuttani R, Bosco JJ (2003) Multicenter randomized trial of the spiral Z-stent compared with the Wallstent for malignant biliary obstruction. Gastrointest Endosc 57: 830–836

    Article  PubMed  Google Scholar 

  30. Binmoeller KF, Seitz U, Seifert H, Thonke F, Sikka S, Soehendra N (1995) The Tannenbaum stent: a new plastic biliary stent without side holes. Am J Gastroenterol 90: 1764–1768

    PubMed  CAS  Google Scholar 

  31. Seitz U, Vadeyar H, Soehendra N (1994) Prolonged patency with a new-design Teflon biliary prosthesis. Endoscopy 26: 478–482

    PubMed  CAS  Google Scholar 

  32. van Berkel AM, Boland C, Redekop WK, Bergman JJ, Groen AK, Tytgat GN, Huibregtse K (1998) A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. Endoscopy 30: 681–686

    PubMed  Google Scholar 

  33. Terruzzi V, Comin U, De Grazia F, Toti GL, Zambelli A, Beretta S, Minoli G (2000) Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis. Gastrointest Endosc 51: 23–27

    Article  PubMed  CAS  Google Scholar 

  34. Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB (1999) Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 49: 466–471

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endoscopy and Motility Unit, Central Hospital, 41 Ethnikis Aminis St., Thessaloniki, 546 35, Greece

    P. Katsinelos, G. Chatzimavroudis, G. Paroutoglou, A. Beltsis & B. Papaziogas

  2. Department of Gastroenterology, “Theagenio” Anticancer Hospital, 2 Al. Symeonidi St., Thessaloniki, 540 07, Greece

    D. Paikos, I. Moschos & A. Gatopoulou

  3. Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, 49 Konstantinoupoleos St., Thessaloniki, 546 42, Greece

    J. Kountouras & C. Zavos

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  1. P. Katsinelos
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  2. D. Paikos
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  3. J. Kountouras
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Correspondence to J. Kountouras.

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Katsinelos, P., Paikos, D., Kountouras, J. et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. Surg Endosc 20, 1587–1593 (2006). https://doi.org/10.1007/s00464-005-0778-1

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  • DOI: https://doi.org/10.1007/s00464-005-0778-1

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