Utility of laser-cut covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a single-center experience

Abstract

Background Few reports have evaluated the effectiveness of laser-cut, covered, self-expandable metal stents (LC-CSEMS) for unresectable malignant distal biliary obstruction (MDBO) and whether reintervention is feasible after placement. We describe our experience with LC-CSEMS placement for unresectable MDBO.

Methods Patients undergoing LC-CSEMS placement for unresectable MDBO from November 2014 to December 2018 were reviewed. Recurrent biliary obstruction (RBO), median time to RBO (TRBO), and reintervention were analyzed.

Results 52 patients who underwent LC-CSEMS placement for unresectable MDBO were included in the analysis. The RBO rate was 15 % and the median TRBO was 445 days. Reintervention was attempted in nine patients and stent removal was successful in eight patients.

Conclusions Our experience suggests the effectiveness of LC-CSEMS in patients with unresectable MDBO in terms of stent patency and feasibility of reintervention.

Publication History

Received: 25 September 2019

Accepted: 10 March 2020

Article published online:
21 April 2020

• References

• 1 Davids PHP, Groen AK, Rauws EAJ. et al. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340: 1488-1492
• 2 Isayama H, Komatsu Y, Tsujino T. et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53: 729-734
• 3 Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 2017; 112: 260-273
• 4 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – updated October 2017. Endoscopy 2018; 50: 910-930
• 5 Kogure H, Ryozawa S, Maetani I. et al. A prospective multicenter study of a fully covered metal stent in patients with distal malignant biliary obstruction: WATCH-2 Study. Dig Dis Sci 2018; 63: 2466-2473
• 6 Isayama H, Nakai Y, Toyokawa Y. et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc 2009; 70: 37-44
• 7 Isayama H, Nakai Y, Hamada T. et al. Understanding the mechanical forces of self-expandable metal stents in the biliary ducts. Curr Gastroenterol Rep 2016; 18: 1-6
• 8 Tanisaka Y, Ryozawa S, Kobayashi M. et al. Endoscopic removal of laser cut covered self expandable metallic biliary stents: a report of six cases. Mol Clin Oncol 2018; 8: 269-273
• 9 Isayama H, Kawakubo K, Nakai Y. et al. A novel, fully covered laser-cut nitinol stent with antimigration properties for nonresectable distal malignant biliary obstruction: a multicenter feasibility study. Gut Liver 2013; 7: 725-730
• 10 Loew BJ, Howell DA, Sanders MK. et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc 2009; 70: 445-453
• 11 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
• 12 Nakai Y, Isayama H, Mukai T. et al. Impact of anticancer treatment on recurrent obstruction in covered metallic stents for malignant biliary obstruction. J Gastroenterol 2013; 48: 1293-1299
• 13 Hamada T, Isayama H, Nakai Y. et al. Antireflux covered metal stent for nonresectable distal malignant biliary obstruction: a multicenter randomized controlled trial. Dig Endosc 2019; 31: 566-574
• 14 Ito K, Ogawa T, Horaguchi J. et al. Reintervention for occluded biliary metal stent for patients with malignant distal biliary stricture. Dig Endosc 2013; 25: 126-131
• 15 Jeong S. Basic knowledge about metal stent development. Clin Endosc 2016; 49: 108-112