nitinol and Biliary-Tract-Neoplasms

Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent.. We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures.. Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency.. Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during follow-up (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively.. The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.

Topics: Aged; Aged, 80 and over; Alloys; Biliary Tract Neoplasms; Biliary Tract Surgical Procedures; Cholangiocarcinoma; Comorbidity; Endoscopy; Feasibility Studies; Female; Follow-Up Studies; Gallbladder Neoplasms; Humans; Kaplan-Meier Estimate; Male; Metals; Middle Aged; Prospective Studies; Prosthesis Design; Reoperation; Stents; Tertiary Care Centers

Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients.. To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction.. Randomized, multicenter trial conducted between January 2006 and October 2008.. Ten sites serving a total catchment area of approximately 2.8 million inhabitants.. A total of 400 patients with unresectable distal malignant biliary obstruction.. ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction.. Time to stent failure, survival time, and complication rate.. The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030).. Randomization was not blinded.. There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Biliary Tract Neoplasms; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Cohort Studies; Disease-Free Survival; Equipment Design; Female; Humans; Male; Middle Aged; Palliative Care; Recurrence; Stents; Treatment Outcome

Topics: Alloys; Biliary Tract Neoplasms; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Cohort Studies; Equipment Design; Humans; Palliative Care; Stents

Topics: Alloys; Biliary Tract Neoplasms; Catheterization; Cholestasis; Female; Follow-Up Studies; Humans; Male; Palliative Care; Patient Selection; Prosthesis Design; Prosthesis Failure; Stainless Steel; Stents; Survival Analysis; Terminally Ill; Treatment Outcome

The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla.. We report on 6 patients in whom trimming of the metallic nitinol stent was performed.. Single-center, retrospective case series.. Secondary referral center.. Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and 1 had a covered gastroduodenal stent.. Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate.. The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively.. In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred.. The study was limited by retrospective design and small sample size.. The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.

Topics: Adenocarcinoma; Aged; Alloys; Argon; Biliary Tract Neoplasms; Device Removal; Electrosurgery; Endoscopy, Gastrointestinal; Female; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Middle Aged; Pancreatic Neoplasms; Stents

The JoStent SelfX is a new biliary uncovered self-expanding nitinol stent. The main advantage of this stent in comparison with the "gold standard" Wallstent is the minimal shortening (< 10 %) that occurs during stent deployment. A prospective feasibility study was conducted to evaluate the method of stent implantation and the stent's short-term efficacy.. Between April 2001 and December 2002, the JoStent SelfX was implanted in 20 patients with inoperable malignant biliary obstructions, mainly caused by pancreatic cancer (12 of 20). All patients underwent sphincterotomy prior to stent insertion. After implantation, laboratory parameters for cholestasis and expansion of the stent were checked over a period of several days. All patients were followed for 8 weeks after implantation to document early stent dysfunction.. Stent implantation was easily managed and successful in all patients, with no technical problems. Prior bougienage was required in only one patient, who had a filiform stenosis. No stent retraction was observed during stent release. All stents showed full expansion within 5 days. No acute complications occurred. Adequate reduction in the elevated laboratory parameters for cholestasis was observed. Two patients had recurrent cholestasis and fever due to cholangitis, or stent occlusion caused by biliary sludge within 4 weeks.. This new biliary metal stent is easily inserted and does not shorten during stent release, allowing precise positioning. No acute complications occurred, but there were two cases of early stent dysfunction. The role of the JoStent SelfX in comparison with other biliary stents will need to be evaluated in a multicenter trial with a larger number of patients, to investigate the long-term results.

Topics: Aged; Aged, 80 and over; Alloys; Biliary Tract Neoplasms; Biliary Tract Surgical Procedures; Female; Humans; Male; Middle Aged; Palliative Care; Pilot Projects; Postoperative Complications; Stents; Treatment Outcome

A new design of endoprosthesis, made of shape-memory nitinol alloy, was used to replace the currently used one, which was soon clogged with bile mud. After nitinol wire coil stent was slenderized in ice water, it was inserted into the strictured bile duct by endoscopy or operation. When nitinol wire coil was positioned in a narrowed biliary segment, normal saline heated to 39 degrees C was rapidly hand-injected into the lumen of the inner transport catheter to make the alloy coil to resume its original shape with a length of 3 to 10cm, and a diameter of 5 to 10mm. Since June 1991, 13 patients with malignant biliary strictures were treated with nitinol endoprosthesis. The follow-up period ranged from 1 to 16 months (average 6 months). Biliary sludge was not found in the endoprosthesis during the period. The results suggested that shape-memory nitinol alloy endoprosthesis could maintain long term patency without severe infection or obstruction due to biliary sludge.

Topics: Adult; Aged; Alloys; Biliary Tract Diseases; Biliary Tract Neoplasms; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Nickel; Stents; Titanium