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Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent.

Han YM, Kwak HS, Jin GY, Lee SO, Chung GH - Korean J Radiol (2007 Sep-Oct)

Bottom Line: Placement was successful in all cases.The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01).The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, Chonju, Korea. ymhan@chonbuk.ac.kr

ABSTRACT

Objective: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction.

Materials and methods: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks).

Results: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively.

Conclusion: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

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Related in: MedlinePlus

A 68-year-old female with common bile duct carcinoma.A. The tubogram taken immediately after stent insertion shows good stent patency and correct positioning.B. This one-week follow-up tubogram shows good stent function. The distance between the end of the stent and the bifurcation of the common hepatic duct shows no change.
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Figure 2: A 68-year-old female with common bile duct carcinoma.A. The tubogram taken immediately after stent insertion shows good stent patency and correct positioning.B. This one-week follow-up tubogram shows good stent function. The distance between the end of the stent and the bifurcation of the common hepatic duct shows no change.

Mentions: Stent deployment was successful in all 37 patients, and this was performed via transpapillary placement of the covered stent (37/37, 100%) (Fig. 2). No proximal or distal stent migration occurred during the procedures. Two patients showed that the stent had migrated completely out of the biliary duct during the 7-week and 27-week follow-up period, respectively. The distance between the bifurcated line and the end of the stent immediately after stent placement was 6-35 mm (mean: 15 mm). One week later, follow-up tubography showed no change of this distance (range: 6-35 mm: mean: 15 mm). The follow-up plain films showed no changes in any of the stents in the right upper quadrant areas except for two patients who experienced delayed stent migration.


Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent.

Han YM, Kwak HS, Jin GY, Lee SO, Chung GH - Korean J Radiol (2007 Sep-Oct)

A 68-year-old female with common bile duct carcinoma.A. The tubogram taken immediately after stent insertion shows good stent patency and correct positioning.B. This one-week follow-up tubogram shows good stent function. The distance between the end of the stent and the bifurcation of the common hepatic duct shows no change.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626809&req=5

Figure 2: A 68-year-old female with common bile duct carcinoma.A. The tubogram taken immediately after stent insertion shows good stent patency and correct positioning.B. This one-week follow-up tubogram shows good stent function. The distance between the end of the stent and the bifurcation of the common hepatic duct shows no change.
Mentions: Stent deployment was successful in all 37 patients, and this was performed via transpapillary placement of the covered stent (37/37, 100%) (Fig. 2). No proximal or distal stent migration occurred during the procedures. Two patients showed that the stent had migrated completely out of the biliary duct during the 7-week and 27-week follow-up period, respectively. The distance between the bifurcated line and the end of the stent immediately after stent placement was 6-35 mm (mean: 15 mm). One week later, follow-up tubography showed no change of this distance (range: 6-35 mm: mean: 15 mm). The follow-up plain films showed no changes in any of the stents in the right upper quadrant areas except for two patients who experienced delayed stent migration.

Bottom Line: Placement was successful in all cases.The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01).The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, Chonju, Korea. ymhan@chonbuk.ac.kr

ABSTRACT

Objective: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction.

Materials and methods: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks).

Results: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively.

Conclusion: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

Show MeSH
Related in: MedlinePlus