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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 76-year-old female with Ampulla of Vater carcinoma.A. The five-day follow-up plain film after stent insertion shows good stent positioning on the air-biliary gram (arrows).B. The 27-week follow-up tubogram after percutaneous transhepatic biliary drainage shows no evidence for the presence of a stent, and there is a small filling defect in the distal common bile duct, which may be a common bile duct stone (arrows).
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Figure 5: A 76-year-old female with Ampulla of Vater carcinoma.A. The five-day follow-up plain film after stent insertion shows good stent positioning on the air-biliary gram (arrows).B. The 27-week follow-up tubogram after percutaneous transhepatic biliary drainage shows no evidence for the presence of a stent, and there is a small filling defect in the distal common bile duct, which may be a common bile duct stone (arrows).

Mentions: Seventy-six percent (28/37) of the study patients experienced adequate palliative drainage for the remainder of their lives. Three patients displayed stent sludge occlusion, and PTBD showed some filling defect in these stents (Fig. 4). However, good stent patency was achieved via irrigation for two patients who both underwent PTBD two times during the follow-up. Two patients had PTBD performed: one patient due to tumor ingrowth (34 weeks) and another due to stent migration (7 weeks). One patient had biliary obstruction 27 weeks after stent insertion. The tubogram finding after PTBD showed stone formation, but we did not find the previously inserted PTFE stent in the abdomen (Fig. 5). One patient underwent percutaneous transhepatic gallbladder drainage at 19 weeks due to acute cholecystitis, and that patient also underwent PTBD at 24 weeks due to overgrowth that was noted at 24 weeks. Two patients had percutaneous transhepatic gallbladder drainage due to acute cholecystitis.


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 76-year-old female with Ampulla of Vater carcinoma.A. The five-day follow-up plain film after stent insertion shows good stent positioning on the air-biliary gram (arrows).B. The 27-week follow-up tubogram after percutaneous transhepatic biliary drainage shows no evidence for the presence of a stent, and there is a small filling defect in the distal common bile duct, which may be a common bile duct stone (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: A 76-year-old female with Ampulla of Vater carcinoma.A. The five-day follow-up plain film after stent insertion shows good stent positioning on the air-biliary gram (arrows).B. The 27-week follow-up tubogram after percutaneous transhepatic biliary drainage shows no evidence for the presence of a stent, and there is a small filling defect in the distal common bile duct, which may be a common bile duct stone (arrows).
Mentions: Seventy-six percent (28/37) of the study patients experienced adequate palliative drainage for the remainder of their lives. Three patients displayed stent sludge occlusion, and PTBD showed some filling defect in these stents (Fig. 4). However, good stent patency was achieved via irrigation for two patients who both underwent PTBD two times during the follow-up. Two patients had PTBD performed: one patient due to tumor ingrowth (34 weeks) and another due to stent migration (7 weeks). One patient had biliary obstruction 27 weeks after stent insertion. The tubogram finding after PTBD showed stone formation, but we did not find the previously inserted PTFE stent in the abdomen (Fig. 5). One patient underwent percutaneous transhepatic gallbladder drainage at 19 weeks due to acute cholecystitis, and that patient also underwent PTBD at 24 weeks due to overgrowth that was noted at 24 weeks. Two patients had percutaneous transhepatic gallbladder drainage due to acute cholecystitis.

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