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Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Endoscopic placement of covered self-expandable metallic stents (CSEMSs) is effective for distal malignant biliary obstruction. However, management of dysfunctional CSEMSs has not been established.

Methods

Between March 1998 and July 2007, a total of 74 patients who underwent endoscopic re-interventions for CSEMS dysfunction were analyzed. Second stent insertion (CSEMS or plastic stent) or mechanical cleaning of the occluded CSEMS was performed endoscopically. The period between second stent insertion and stent dysfunction or patient death (time to dysfunction; TTD) was calculated. The cleaned initial CSEMSs were analyzed as second stents.

Results

Dysfunction of the second stent occurred in 17 of 37 patients (45.9 %) in the CSEMS group, 16 of 20 (80.0 %) in the plastic stent group, and 13 of 17 (76.5 %) in the cleaning group. The median TTD of each group was 176, 57, and 46 days, respectively. The cumulative TTD was significantly higher in the CSEMS group than in the plastic stent and cleaning groups (P = 0.08). From the multivariate analysis, sludge occlusion of the first CSEMS was identified as a significant risk factor for second stent dysfunction (HR, 2.51; 95 % CI, 1.19–5.46), and placement of the second CSEMS significantly reduced the risk of dysfunction (HR, 0.39; 95 % CI, 0.18–0.79).

Conclusions

Insertion of a new CSEMS should be considered as the treatment of choice for the management of dysfunctional CSEMSs.

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References

  1. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.

    Article  CAS  PubMed  Google Scholar 

  2. Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207–12.

    Article  CAS  PubMed  Google Scholar 

  3. Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am. J Gastroenterol. 1996;91:654–9.

    CAS  PubMed  Google Scholar 

  4. O’Brien S, Hatfield AR, Craig PI, Williams SP. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut. 1995;36:618–21.

    Article  PubMed  Google Scholar 

  5. Dumonceau JM, Cremer M, Auroux J, Delhaye M, Deviere J. A comparison of Ultraflex Diamond stents and Wallstents for palliation of distal malignant biliary strictures. Am J Gastroenterol. 2000;95:670–6.

    Article  CAS  PubMed  Google Scholar 

  6. Miyayama S, Matsui O, Terayama N, Tatsu H, Yamamoto T, Takashima T. Covered gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol. 1997;8:641–8.

    Article  CAS  PubMed  Google Scholar 

  7. Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G. Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up. Cardiovasc Intervent Radiol. 1997;20:441–7.

    Article  CAS  PubMed  Google Scholar 

  8. Hausegger KA, Thurnher S, Bodendorfer G, Zollikofer CL, Uggowitzer M, Kugler C, et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR. 1998;170:403–8.

    Article  CAS  PubMed  Google Scholar 

  9. Isayama H, Komatsu Y, Tsujino T, Yoshida H, Tada M, Shiratori Y, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002;55:366–70.

    Article  PubMed  Google Scholar 

  10. Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53:729–34.

    Article  CAS  PubMed  Google Scholar 

  11. Nakai Y, Isayama H, Komatsu Y, Tsujino T, Toda N, Sasahira N, et al. Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005;62:742–8.

    Article  PubMed  Google Scholar 

  12. Kahaleh M, Tokar J, Conaway MR, Brock A, Le T, Adams RB, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc. 2005;61:528–33.

    Article  PubMed  Google Scholar 

  13. Soderlund C, Linder S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc. 2006;63:986–95.

    Article  PubMed  Google Scholar 

  14. Yoon WJ, Lee JK, Lee KH, Lee WJ, Ryu JK, Kim YT, et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.

    Article  PubMed  Google Scholar 

  15. Park do H, Kim MH, Choi JS, Lee SS, Seo DW, Kim JH, et al. Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol. 2006;4:790–6.

    Google Scholar 

  16. Matsushita M, Takakuwa H, Nishio A, Kido M, Shimeno N. Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents. Gastrointest Endosc. 2003;58:924–7.

    Article  PubMed  Google Scholar 

  17. Wamsteker EJ, Elta GH. Migration of covered biliary self-expanding metallic stents in two patients with malignant biliary obstruction. Gastrointest Endosc. 2003;58:792–3.

    Article  PubMed  Google Scholar 

  18. Togawa O, Kawabe T, Isayama H, Nakai Y, Sasaki T, Arizumi T, et al. Management of occluded uncovered metallic stents in patients with malignant distal biliary obstructions using covered metallic stents. J Clin Gastroenterol. 2008;42:546–9.

    Article  CAS  PubMed  Google Scholar 

  19. Speer AG, Cotton PB, Rode J, Seddon AM, Neal CR, Holton J, et al. Biliary stent blockage with bacterial biofilm. A light and electron microscopy study. Ann Intern Med. 1988;108:546–53.

    Article  CAS  PubMed  Google Scholar 

  20. Leung JW, Liu Y, Chan RC, Tang Y, Mina Y, Cheng AF, et al. Early attachment of anaerobic bacteria may play an important role in biliary stent blockage. Gastrointest Endosc. 2000;52:725–9.

    Article  CAS  PubMed  Google Scholar 

  21. Bethge N, Sommer A, Gross U, von Kleist D, Vakil N. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc. 1996;43:596–602.

    Article  CAS  PubMed  Google Scholar 

  22. Silvis SE, Sievert CE Jr, Vennes JA, Abeyta BK, Brennecke LH. Comparison of covered versus uncovered wire mesh stents in the canine biliary tract. Gastrointest Endosc. 1994;40:17–21.

    Article  CAS  PubMed  Google Scholar 

  23. Shin HP, Kim MH, Jung SW, Kim JC, Choi EK, Han J, et al. Endoscopic removal of biliary self-expandable metallic stents: a prospective study. Endoscopy. 2006;38:1250–5.

    Article  CAS  PubMed  Google Scholar 

  24. Familiari P, Bulajic M, Mutignani M, Lee LS, Spera G, Spada C, et al. Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc. 2005;62:903–10.

    Article  PubMed  Google Scholar 

  25. Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic Wallstents. Gastrointest Endosc. 2004;60:640–4.

    Article  PubMed  Google Scholar 

  26. Tham TC, Carr-Locke DL, Vandervoort J, Wong RC, Lichtenstein DR, Van Dam J, et al. Management of occluded biliary Wallstents. Gut. 1998;42:703–7.

    CAS  Google Scholar 

  27. Bueno JT, Gerdes H, Kurtz RC. Endoscopic management of occluded biliary Wallstents: a cancer center experience. Gastrointest Endosc. 2003;58:879–84.

    Article  PubMed  Google Scholar 

  28. Isayama H, Nakai Y, Toyokawa Y, Togawa O, Gon C, Ito Y, et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc. 2009;70:37–44.

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

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

    Osamu Togawa, Hiroyuki Isayama, Takeshi Tsujino, Yousuke Nakai, Hirofumi Kogure, Tsuyoshi Hamada, Takashi Sasaki, Yoko Yashima, Hiroshi Yagioka, Toshihiko Arizumi, Saburo Matsubara, Natsuyo Yamamoto, Naoki Sasahira, Kenji Hirano, Minoru Tada & Kazuhiko Koike

  2. Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan

    Osamu Togawa

  3. Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan

    Yukiko Ito

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

    Nobuo Toda

Authors
  1. Osamu Togawa
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  2. Hiroyuki Isayama
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  3. Takeshi Tsujino
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  4. Yousuke Nakai
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  9. Hiroshi Yagioka
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  10. Toshihiko Arizumi
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  11. Yukiko Ito
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  13. Natsuyo Yamamoto
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  14. Naoki Sasahira
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  15. Kenji Hirano
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  17. Minoru Tada
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  18. Kazuhiko Koike
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Corresponding author

Correspondence to Hiroyuki Isayama.

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Togawa, O., Isayama, H., Tsujino, T. et al. Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction. J Gastroenterol 48, 1300–1307 (2013). https://doi.org/10.1007/s00535-013-0751-z

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  • DOI: https://doi.org/10.1007/s00535-013-0751-z

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