Antireflux Metal Stent As a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study

Overview

Journal Gut Liver

Specialty Gastroenterology

Date 2016 Jun 11

PMID 27282268

Citations 10

Authors

Tsuyoshi Hamada

Hiroyuki Isayama

Yousuke Nakai

Osamu Togawa

Naminatsu Takahara

Rie Uchino

Suguru Mizuno

Dai Mohri

Hiroshi Yagioka

Hirofumi Kogure

Saburo Matsubara

Natsuyo Yamamoto

Yukiko Ito

Minoru Tada

Kazuhiko Koike

Affiliations

Soon will be listed here.

Abstract

Background/aims: In distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent.

Methods: Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement.

Results: In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced nonocclusion cholangitis.

Conclusions: The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted.

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References

Nakai Y, Isayama H, Tsujino T, Sasahira N, Hirano K, Kogure H . Impact of introduction of wire-guided cannulation in therapeutic biliary endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. 2011; 26(10):1552-8. DOI: 10.1111/j.1440-1746.2011.06788.x. View

Knyrim K, Wagner H, Pausch J, Vakil N . A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993; 25(3):207-12. DOI: 10.1055/s-2007-1010294. View

Nakai Y, Isayama H, Komatsu Y, Tsujino T, Toda N, Sasahira N . Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005; 62(5):742-8. DOI: 10.1016/j.gie.2005.06.030. View

Hamada T, Isayama H, Nakai Y, Kogure H, Yamamoto N, Koike K . Tips and troubleshooting for transpapillary metal stenting for distal malignant biliary obstruction. J Hepatobiliary Pancreat Sci. 2014; 21(3):E12-8. DOI: 10.1002/jhbp.51. View

Ornellas L, Stefanidis G, Chuttani R, Gelrud A, Kelleher T, Pleskow D . Covered Wallstents for palliation of malignant biliary obstruction: primary stent placement versus reintervention. Gastrointest Endosc. 2009; 70(4):676-83. DOI: 10.1016/j.gie.2009.02.012. View

Isayama H, Kawabe T, Nakai Y, Ito Y, Togawa O, Kogure H . Management of distal malignant biliary obstruction with the ComVi stent, a new covered metallic stent. Surg Endosc. 2009; 24(1):131-7. DOI: 10.1007/s00464-009-0537-9. View

Kawakubo K, Isayama H, Nakai Y, Togawa O, Sasahira N, Kogure H . Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc. 2011; 26(3):771-6. DOI: 10.1007/s00464-011-1950-4. View

Lee K, Chung M, Park J, Lee D, Jung S, Bang B . Clinical advantages of a metal stent with an S-shaped anti-reflux valve in malignant biliary obstruction. Dig Endosc. 2013; 25(3):308-12. DOI: 10.1111/j.1443-1661.2012.01382.x. View

Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr H, 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(4):654-9. View

10.

Davids P, Groen A, Rauws E, Tytgat G, Huibregtse K . Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992; 340(8834-8835):1488-92. DOI: 10.1016/0140-6736(92)92752-2. View

11.

Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N . A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction. Gut. 2004; 53(5):729-34. PMC: 1774024. DOI: 10.1136/gut.2003.018945. View

12.

Lammer J, Hausegger K, Fluckiger F, Winkelbauer F, Wildling R, Klein G . Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology. 1996; 201(1):167-72. DOI: 10.1148/radiology.201.1.8816539. View

13.

Togawa O, Isayama H, Tsujino T, Nakai Y, Kogure H, Hamada T . Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction. J Gastroenterol. 2013; 48(11):1300-7. DOI: 10.1007/s00535-013-0751-z. View

14.

Saleem A, Leggett C, Murad M, Baron T . Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011; 74(2):321-327.e1-3. DOI: 10.1016/j.gie.2011.03.1249. View

15.

Isayama H, Mukai T, Itoi T, Maetani I, Nakai Y, Kawakami H . Comparison of partially covered nitinol stents with partially covered stainless stents as a historical control in a multicenter study of distal malignant biliary obstruction: the WATCH study. Gastrointest Endosc. 2012; 76(1):84-92. DOI: 10.1016/j.gie.2012.02.039. View

16.

Nakai Y, Isayama H, Togawa O, Kogure H, Tsujino T, Yagioka H . New method of covered wallstents for distal malignant biliary obstruction to reduce early stent-related complications based on characteristics. Dig Endosc. 2011; 23(1):49-55. DOI: 10.1111/j.1443-1661.2010.01043.x. View

17.

Hamada T, Nakai Y, Isayama H, Sasaki T, Kogure H, Kawakubo K . Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: an analysis using a time-dependent covariate. Surg Endosc. 2012; 27(4):1243-8. DOI: 10.1007/s00464-012-2585-9. View

18.

Moon S, Kim M, Park D, Song T, Eum J, Lee S . Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc. 2010; 72(1):86-91. DOI: 10.1016/j.gie.2010.01.063. View

19.

Wen F, Lu Z, Mao X, Liang H, Guo Q . Bridging across the ampulla with metal stents: evidences for intestinal bile reflux. Hepatogastroenterology. 2014; 60(128):1903-5. View

20.

Isayama H, Hamada T, Yasuda I, Itoi T, Ryozawa S, Nakai Y . TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2014; 27(2):259-64. DOI: 10.1111/den.12379. View