A novel laser-cut fully covered metal stent with anti-reflux valve in patients with malignant distal biliary obstruction refractory to conventional covered metal stent.

Abstract

BACKGROUND:

Stenting against recurrent biliary obstruction (RBO) after placement of covered metal stent (CMS) for distal malignant biliary obstruction (MBO) is still challenging. This study investigated the feasibility of a novel laser-cut fully CMS with anti-reflux valve in patients with distal MBO refractory to conventional CMS.

METHODS:

Patients who underwent Duckbill-type metal stent (DMS) placement between June 2019 and May 2020 were included. Early complications, causes of RBO including non-occlusion cholangitis, and time to RBO (TRBO) were evaluated. TRBO of DMS was also compared with that of previous CMS.

RESULTS:

Thirty patients were included: pancreatic cancer/metastatic lymph nodes in 29 patients/one patient; duodenal stenosis in 13 patients. Technical and functional success were achieved in all patients. Mild cholangitis and mild pancreatitis developed in each one. Median follow-up period was 167 days (range, 23-527 days). RBO occurred in nine patients (30%): sludge formation in four patients, hemobilia in one patient, symptomatic distal stent migration in three patients, and non-occlusion cholangitis in one patient. TRBO of DMS was significantly longer than that of previous CMS (median 224 days vs median 120 days, P = .0025). DMS was successfully removed in all of six patients when re-intervention was needed.

CONCLUSIONS:

Duckbill-type metal stent might be safe and effective in patients with distal MBO refractory to conventional CMS.

• Authors: Yuto Yamada, Takashi Sasaki, Tsuyoshi Takeda, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Yoshinori Igarashi, Naoki Sasahira
• Journal: Journal of hepato-biliary-pancreatic sciences (J Hepatobiliary Pancreat Sci) Vol. 28 Issue 7 Pg. 563-571 (Jul 2021) ISSN: 1868-6982 [Electronic] Japan
• PMID: 33835728 (Publication Type: Journal Article)
• Copyright: © 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Topics

• Cholestasis (diagnostic imaging, etiology, surgery)
• Digestive System Abnormalities
• Duodenal Obstruction
• Humans
• Lasers
• Stents