nitinol and Jaundice--Obstructive

To prospectively evaluate safety and efficacy of biliary stent placement with iodine-125 (. From July 2011 to June 2014, 55 patients were enrolled (group A, 11 men and 17 women, mean age 70.93 y ± 8.58; group B, 14 men and 13 women, mean age 70.26 y ± 9.71). All patients were randomly assigned to placement of a biliary stent with. Stents were successfully placed in all 55 patients. MOJ was relieved in all patients, and there were no significant differences in complications related to stent insertion between the 2 groups. Mean and median stent patency were 191 days ± 19.8 (95% confidence interval [CI], 152-230 d) and 179 days ± 191.4 (95% CI, 87-267 d) in group A and 88.3 days ± 16.3 (95% CI, 61-114 d) and 77 days ± 88.2 (95% CI, 65-86 d) in group B (P < .001, log-rank test). Mean and median survival time were 222.6 days ± 21.0 (95% CI, 181-263 d) and 241 days ± 18.2 (95% CI, 179-270 d) in group A and 139.1 days ± 14.5 (95% CI, 110-167 d) and 142 days ± 16.3 (95% CI, 83-177 d) in group B (P < .001, log-rank test).

Topics: Aged; Aged, 80 and over; Alloys; Brachytherapy; China; Cholestasis; Digestive System Neoplasms; Female; Humans; Iodine Radioisotopes; Jaundice, Obstructive; Kaplan-Meier Estimate; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiography, Interventional; Risk Factors; Self Expandable Metallic Stents; Time Factors; Treatment Outcome

The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene/fluorinated-ethylene-propylene (ePTFE/FEP)-covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in half of the patients, and ePTFE/FEP-covered stents were used in the remaining patients. Patency, survival, complications, and mean cost were calculated in both groups. Mean patency was 166.0 ± 13.11 days for the bare-stent group and 234.0 ± 20.87 days for the covered-stent group (p = 0.007). Primary patency rates at 3, 6, and 12 months were 77.5, 69.8, and 69.8% for the bare-stent group and 97.5, 92.2, and 87.6% for the covered-stent group, respectively. Mean secondary patency was 123.7 ± 22.5 days for the bare-stent group and 130.3 ± 21.4 days for the covered-stent group. Tumour ingrowth occurred exclusively in the bare-stent group in 27.5% of cases (p = 0.002). Median survival was 203.2 ± 11.8 days for the bare-stent group and 247.0 ± 20 days for the covered-stent group (p = 0.06). Complications and mean cost were similar in both groups. Regarding primary patency and ingrowth rate, ePTFE/FEP-covered stents have shown to be significantly superior to bare nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer and pose comparable cost and complications. Use of a covered stent does not significantly influence overall survival rate; nevertheless, the covered endoprosthesis seems to offer result in fewer reinterventions and better quality of patient life.

Topics: Adult; Aged; Alloys; Biliary Tract Surgical Procedures; Coated Materials, Biocompatible; Female; Humans; Jaundice, Obstructive; Male; Middle Aged; Palliative Care; Pancreas; Pancreatic Neoplasms; Polytetrafluoroethylene; Prospective Studies; Prosthesis Design; Prosthesis Implantation; Stents; Survival Analysis; Treatment Outcome

Topics: Aged; Alloys; Anastomosis, Surgical; Common Bile Duct; Female; Gastrostomy; Humans; Jaundice, Obstructive; Stents; Stomach; Ultrasonography, Interventional

to analyze the effectiveness and possible complications of endoscopic biliary drainage (BD) using self-expanding metal stent (SEMS) in patients with malignant jaundice (MJ).. From January 2010 to January 2014 in endoscopy department of Pirogov National medical and surgical Center were operated 64 patients with MJ, 38 of them with SEMS. The average patient's age was 65.4 ± 14.5 years. The mean duration of jaundice was 13 ± 5.4 days before drainage. The remaining 6 patients (15.8%) were operated with preliminary PTBD. In all 38 patients were diagnosed unresectable tumors.. successful endoscopic BD were achieved in all 38 patients. 35 patients were drained with transpapillary SEMS and 3 patients with EUS-guided choledochoduodenoanastomoses (EUS-CDA). Early postoperative complications were observed in 3 (7.8%) patients with no lethality.. endoscopic BD with SEMS is an effective method of internal drainage for inoperable pancreatobiliary tumors, providing adequate BD for the entire duration of life expectancy. In case of failed transpapillary drainage EUS-guided biliodigestive anastomoses were performed. The complication rate of endoscopic BD in patients with malignant pancreatobiliary tumors in our study was 7.8% and comparable with complication level due to ERCP/EST for benign pathology.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Endoscopy, Gastrointestinal; Female; Humans; Jaundice, Obstructive; Liver Neoplasms; Male; Middle Aged; Radiography; Retrospective Studies; Stents

Nitinol self-expanding stents were used in treatment of 15 patients with blastomatous lesions of biliopancreatoduodenal zone. Stenting was successful in all cases, long-term results were obtained in all patients. Death occurred in 8 patients within 5,5-11 month after stent insertion. 7 patients remain under observation. In 6 patients nitinol stents remain open with no signs of occlusion from 2,5 to 15 months' observation period. Jaundice recurred in one patient after 11 month after the insertion due to stent occlusion. Thus, stenting proved to be an effective and safe method of bile flow restoration by tumor biliary tract obstruction.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Bile Duct Neoplasms; Duodenal Neoplasms; Endoscopy, Digestive System; Female; Humans; Jaundice, Obstructive; Male; Middle Aged; Pancreatic Neoplasms; Prosthesis Design; Stents; Treatment Outcome

Studies have shown that SEMS remain patient longer with fewer associated complications compared with conventional plastic strents. Zilver stent, a nitinol zig-zag mash SEMS has a special advantage, having a thin introducer diameter of 7 Fr with a fully deployed span of 10mm. For a 48-year-old woman presented with obstructive jaundice and a diagnosis of unresectable pancreatic carcinoma with consequent stenosis of common bile duct (CBD), infiltration of local blood vessels and life expectancy longer than six months, it was decided that an endoscopic palliative drainage procedure should be performed. The technique of transendoscopic plastic to metal stent exchange is described, using a diagnostic duodenoscope. The patient lived 7 months after implementation of Zilver stent and died anicteric due to progression of a primary disease. The transendoscopic plastic to metal stent exchange is feasible palliative method which requires a basic endoscopic equipment and experienced staff and therefore is applicable in developing countries as well.

Topics: Alloys; Common Bile Duct; Duodenoscopes; Duodenoscopy; Female; Humans; Jaundice, Obstructive; Palliative Care; Pancreatic Neoplasms; Plastics; Stents

Malignant biliary obstruction may be caused by cholangiocarcinoma and other nonbiliary carcinomas. At the time of diagnosis, 90% of patients with malignant obstructive jaundice may benefit from palliative treatment only. The objective of palliation is to relieve jaundice-related symptoms, prevent cholangitis, prolong survival, and improve quality of life. Percutaneous transhepatic biliary stenting is a well-established procedure used in patients with malignant obstruction of intra- and extrahepatic bile ducts. Twelve patients (9 women, 3 men; mean age, 68 years; range, 44-88 years) with inoperable malignant biliary obstruction were selected for percutaneous transhepatic biliary stenting with metallic stents in the period from January to December 2007. Technical and clinical success rate in this patient series was 83% and 80%, respectively. Minor and major complications occurred in 17% and 8% of cases, respectively, which is in the range reported by the others. This is our first experience of percutaneous transhepatic biliary stenting at the Hospital of Kaunas University of Medicine and, to our knowledge, the first reported patient series in Lithuania. These first results encourage expanding effective palliation by the employment of the percutaneous transhepatic biliary stenting in patients with nonresectable malignant biliary obstruction or in case of a recurrent disease after curative surgery. The cost effectiveness of percutaneous transhepatic biliary stenting against percutaneous transhepatic biliary drainage has yet to be evaluated in a prospective manner. However, immediate clinical benefits and positive short-term outcomes are unequivocal.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cholestasis; Drainage; Endoscopy; Female; Follow-Up Studies; Gallbladder Neoplasms; Humans; Jaundice, Obstructive; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Patient Selection; Postoperative Complications; Quality of Life; Radiography; Stainless Steel; Stents; Time Factors; Treatment Outcome

To evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma (HCC).. Fifteen men (mean age, 59.3 years) with obstructive jaundice resulting from HCC were treated with self-expandable metallic stents (28 stents in 19 sessions). The authors evaluated the technical success, clinical success (decrease of 30% of total serum bilirubin level or <2 mg/dL [34.2 micromol/L]), treatment efficacy according to lowest total serum bilirubin level, complications, and duration of stent patency.. Technical success was achieved in all patients. Clinical success was achieved in 11 of the 15 patients (73%). After stent placement, seven patients (47%) had a low bilirubin level (<2 mg/dL [34.2 micromol/L]), three (20%) had an intermediate bilirubin level (2-10 mg/dL [34.2-171 micromol/L]), and five (33%) had a high bilirubin level (>10 mg/dL [171 micromol/L]). A low bilirubin level was achieved in all patients with Child-Pugh A disease and stage T2 or T3 HCC. Major complications such as hemobilia necessitating transfusion (n=1) or abscess formation (n=1) occurred in two of the 19 sessions (10%). The overall mean stent patency was 149.8 days (range, 12-790 days). The mean stent patency in patients with Child-Pugh class A disease (257.8 days) was significantly longer than that of patients with Child-Pugh class B and C disease (123.2 and 63 days, respectively) (P<.05).. The percutaneous placement of a self-expandable metallic stent is a feasible and effective palliative treatment for patients with obstructive jaundice resulting from HCC, especially for those with Child-Pugh class A disease and stage T2 or T3 HCC.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Carcinoma, Hepatocellular; Catheterization; Doxorubicin; Female; Fluoroscopy; Humans; Iodized Oil; Jaundice, Obstructive; Liver Neoplasms; Male; Middle Aged; Radiography, Interventional; Retrospective Studies; Statistics, Nonparametric; Stents; Treatment Outcome; Ultrasonography, Interventional