nitinol and Liver-Neoplasms

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

A 6F endoscopic biliary self-expanding metal stent (SEMS) has been newly introduced for intended simultaneous side-by-side bilateral deployment in hilar malignant obstruction.. To report our initial experience with the Zilver 635 biliary SEMS.. Retrospective chart review.. Tertiary referral medical center.. Sixteen consecutive malignant hilar biliary obstruction patients.. Endoscopic palliative treatment of malignant biliary obstruction with the Zilver 635 SEMS from December 2008 to January 2010.. Technical/functional success rates, early complications (within 30 days of stent placement), early/late stent occlusion, and biliary reintervention rates.. A total of 49 Zilver SEMSs were placed in 16 patients (mean age 61 years, 6 men) for Bismuth type II (n = 4), III (n = 5), and IV (n = 7) lesions. Twelve had cholangiocarcinoma, 2 had metastatic colon cancer, 1 had lung cancer, and 1 had pancreatic cancer. The technical success rate was 100%. Side-by-side simultaneous bilateral stent deployment was required and was achieved successfully in 10 cases. Additional transpapillary stents were placed for potential future biliary access. The 30-day mortality rate was 0%. There were 1 early (6%) and 3 late (19%) stent occlusions. Successful overall biliary drainage was 75%.. Small sample size, uncontrolled retrospective study.. Malignant hilar biliary obstruction endoscopic palliation with the Zilver 635 SEMS offers acceptable initial feasibility, safety, and efficacy profiles. The current design facilitates smaller bile duct negotiation and more precise intrahepatic placement. Expanding available lengths would allow transpapillary bridged bilateral SEMS placement for future reobstructed biliary access. Further long-term studies are required for comparative outcomes with other current SEMS technology.

Topics: Adult; Aged; Alloys; Bile Duct Neoplasms; Cholangiocarcinoma; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Intrahepatic; Colonic Neoplasms; Duodenoscopes; Equipment Design; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Palliative Care; Retrospective Studies; Stents

Self-expandable metal stents (SEMSs) made from nitinol (N) were developed as a potentially more effective alternative to conventional stainless steel (SS) stents.. To compare clinical outcomes of N versus SS stents in the management of malignant biliary strictures.. Retrospective study.. Tertiary-care cancer center.. All patients with first-time N (Flexxus) and SS (Wallstent) uncovered biliary SEMSs placed between January 2006 and October 2007.. SEMS placement.. A total of 81 N and 96 SS stents were placed. The most common cancer diagnosis was pancreatic (80.2% N; 62.5% SS; P = .06). The most frequent site of stricture was the common bile duct (85.2% N; 86.5% SS; P = .31). Biliary decompression was achieved in 93.8% of the N group and 86.4% of the SS group (P = .22). Immediate stent manipulation was required in 4 patients in each group. Subsequent intervention for poor drainage was performed in 17 N (21%) and 26 SS (27%) stents at mean times of 142.1 days (range, 5-541 days; median, 77 days) and 148.1 days (range, 14-375; median, 158.5), respectively (P = .17). The occlusion rate between N and SS stents was not significant (P = .42). The overall durations of stent patency in the N and SS group were similar (median 129 and 137 days, respectively; P = .61), including the subgroup analysis performed on patients with pancreatic cancer (P = .60) and common duct strictures (P = .77). Complication rates were low in both groups (early: 3.7% N, 6.3% SS; late: 2.5% N, 3.1% SS). Ninety percent underwent chemotherapy and 38% radiation therapy in each group.. Retrospective design.. Similar outcomes were achieved with N and SS stents regarding efficacy, duration of stent patency, occlusion rates, and complications. Our results are most applicable to patients with common duct strictures and pancreatic cancer.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Ampulla of Vater; Cholangiocarcinoma; Cholestasis, Extrahepatic; Common Bile Duct Neoplasms; Equipment Failure Analysis; Female; Hepatic Duct, Common; Humans; Liver Function Tests; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms; Prosthesis Design; Recurrence; Retreatment; Retrospective Studies; Stainless Steel; Stents

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

Topics: Alloys; Blood Vessel Prosthesis Implantation; Carcinoma, Hepatocellular; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Phlebography; Prosthesis Design; Stents; Vena Cava, Inferior; Venous Thrombosis

The use of self-expanding metallic stents (SEMS) as esophageal endoprosthesis represents an advancement in the palliation of dysphagia from unresectable esophageal carcinoma. However, the problem of stent migration persists. Although most migrated stents have a benign outcome, complications do occur. Rare reports of intestinal obstruction have been confined to the stiff plastic and stainless-steel stents. We report the first case of intestinal obstruction secondary to the pliable Nitinol SEMS (Ultraflex) migration.

Topics: Adenocarcinoma; Aged; Alloys; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deglutition Disorders; Device Removal; Epirubicin; Equipment Design; Esophageal Neoplasms; Fluorouracil; Foreign-Body Migration; Humans; Ileal Diseases; Intestinal Obstruction; Laparotomy; Liver Neoplasms; Male; Postoperative Complications; Stents

To evaluate the treatment of malignant biliary stenoses and occlusions using a new stent.. In a prospective study, 25 patients with malignant obstructive jaundice were treated with SMART(R) stents. The handling and the quality of stent expansion were documented. Stent function was assessed 2 - 4 days after intervention by cholangiography and laboratory tests. A follow-up was performed three months, after stent placement.. All lesions were treated successfully, with a total of 35 stents implanted. In 14 patients a further balloon dilatation was performed after stent placement (8 - 10 mm diameter/ 40 - 80 mm length). The mean serum bilirubin level decreased significantly from 11.6 mg/dl to 4.6 mg/dl after intervention (p < 0.05). The follow-up showed a mean serum bilirubin level at 4.0 mg/dl. In 4 cases (16 %) a further intervention (PTCD or stent) was performed. Six patients died due to tumor progression. The stents proved to be patent in 79 % (n = 15) of patients alive at the time of follow-up.. Placement of the SMART stent for the therapy of malignant biliary lesions yields good technical and clinical results.

Topics: Aged; Aged, 80 and over; Alloys; Bilirubin; Breast Neoplasms; Carcinoma, Hepatocellular; Cholestasis; Colonic Neoplasms; Drainage; Female; Follow-Up Studies; Humans; Klatskin Tumor; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms; Prospective Studies; Radiography; Reoperation; Stents; Stomach Neoplasms; Time Factors