Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction

Jae Hee Cho, Tae Joo Jeon, Jeong Youp Park, Hee Man Kim, Yoon Jae Kim, Seung Woo Park, Jae Bock Chung, Si Young Song, Seungmin Bang

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction.Methods Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as "stent-in-stent" at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncoveredcovered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncoveredplastic). Results The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p = 0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR = 2.04, CI = 1.08-3.86) and survival time (HR = 2.37, CI = 1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR = 0.27, CI = 0.08-0.98) and survival (HR = 0.17, CI = 0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR = 0.50, CI = 0.26-0.99). Conclusions The placement of additional biliary stents using the "stent-in-stent" method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.

Original languageEnglish
Pages (from-to)475-482
Number of pages8
JournalSurgical endoscopy
Volume25
Issue number2
DOIs
Publication statusPublished - 2011 Feb

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Plastics
Stents
Membranes
Survival
Self Expandable Metallic Stents
Neoplasms
Ampulla of Vater
Korea
Sewage

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Cho, Jae Hee ; Jeon, Tae Joo ; Park, Jeong Youp ; Kim, Hee Man ; Kim, Yoon Jae ; Park, Seung Woo ; Chung, Jae Bock ; Song, Si Young ; Bang, Seungmin. / Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. In: Surgical endoscopy. 2011 ; Vol. 25, No. 2. pp. 475-482.
@article{ac4a104c63884958a9ecc0f3a9bc501f,
title = "Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction",
abstract = "Background The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction.Methods Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as {"}stent-in-stent{"} at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncoveredcovered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncoveredplastic). Results The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p = 0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR = 2.04, CI = 1.08-3.86) and survival time (HR = 2.37, CI = 1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR = 0.27, CI = 0.08-0.98) and survival (HR = 0.17, CI = 0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR = 0.50, CI = 0.26-0.99). Conclusions The placement of additional biliary stents using the {"}stent-in-stent{"} method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.",
author = "Cho, {Jae Hee} and Jeon, {Tae Joo} and Park, {Jeong Youp} and Kim, {Hee Man} and Kim, {Yoon Jae} and Park, {Seung Woo} and Chung, {Jae Bock} and Song, {Si Young} and Seungmin Bang",
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Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. / Cho, Jae Hee; Jeon, Tae Joo; Park, Jeong Youp; Kim, Hee Man; Kim, Yoon Jae; Park, Seung Woo; Chung, Jae Bock; Song, Si Young; Bang, Seungmin.

In: Surgical endoscopy, Vol. 25, No. 2, 02.2011, p. 475-482.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction

AU - Cho, Jae Hee

AU - Jeon, Tae Joo

AU - Park, Jeong Youp

AU - Kim, Hee Man

AU - Kim, Yoon Jae

AU - Park, Seung Woo

AU - Chung, Jae Bock

AU - Song, Si Young

AU - Bang, Seungmin

PY - 2011/2

Y1 - 2011/2

N2 - Background The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction.Methods Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as "stent-in-stent" at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncoveredcovered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncoveredplastic). Results The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p = 0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR = 2.04, CI = 1.08-3.86) and survival time (HR = 2.37, CI = 1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR = 0.27, CI = 0.08-0.98) and survival (HR = 0.17, CI = 0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR = 0.50, CI = 0.26-0.99). Conclusions The placement of additional biliary stents using the "stent-in-stent" method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.

AB - Background The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction.Methods Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as "stent-in-stent" at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncoveredcovered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncoveredplastic). Results The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p = 0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR = 2.04, CI = 1.08-3.86) and survival time (HR = 2.37, CI = 1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR = 0.27, CI = 0.08-0.98) and survival (HR = 0.17, CI = 0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR = 0.50, CI = 0.26-0.99). Conclusions The placement of additional biliary stents using the "stent-in-stent" method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.

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U2 - 10.1007/s00464-010-1196-6

DO - 10.1007/s00464-010-1196-6

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JO - Surgical Endoscopy

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