A Novel, Fully Covered Laser-Cut Nitinol Stent with Antimigration Properties for Nonresectable Distal Malignant Biliary Obstruction: A Multicenter Feasibility Study
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Background/Aims: Stent migration occurs frequently, but the prevention of complications resulting from covered selfexpandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. Methods: Between February 2010 and January 2011,an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications,and overall survival. Results: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. Conclusions: m-CZSs with antimigration properties effectively,although not completely, prevented stent migration after stent insertion.
Abstract
Background/Aims: Stent migration occurs frequently, but the prevention of complications resulting from covered selfexpandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. Methods: Between February 2010 and January 2011,an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications,and overall survival. Results: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. Conclusions: m-CZSs with antimigration properties effectively,although not completely, prevented stent migration after stent insertion.
참고문헌 (19)
- Isayama H, "A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction", Gut, 53, pp.729~734 (2004)
- Saleem A, "Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction", Gastrointest Endosc, 74, pp.321~327 (2011)
- Tada M, "Recent progress and limitations of chemotherapy for pancreatic and biliary tract cancers", World J Clin Oncol, 2, pp.158~163 (2011)
- Nakai Y, "Efficacy and safety of metallic stents in patients with unresectable pancreatic cancer receiving gemcitabine", Pancreas, 37, pp.405~410 (2008)
- Isayama H, "Measurement of radial and axial forces of biliary self-expandable metallic stents", Gastrointest Endosc, 70, pp.37~44 (2009)
- Nakai Y, "New method of covered wallstents for distal malignant biliary obstruction to reduce early stent-related complications based on characteristics", Dig Endosc, 23, pp.49~55 (2011)
- Moon SH, "Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration", Gastrointest Endosc, 72, pp.86~91 (2010)
- Park do H, "Anchoring flap versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos)", Gastrointest Endosc, 73, pp.64~70 (2011)
- Isayama H, "Polyurethane-covered metal stent for management of distal malignant biliary obstruction", Gastrointest Endosc, 55, pp.366~370 (2002)
- Nakai Y, "Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction", Gastrointest Endosc, 62, pp.742~748 (2005)
- Isayama H, "Management of distal malignant biliary obstruction with the ComVi stent, a new covered metallic stent", Surg Endosc, 24, pp.131~137 (2010)
- Telford JJ, "A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction", Gastrointest Endosc, 72, pp.907~914 (2010)
- Kullman E, "Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study", Gastrointest Endosc, 72, pp.915~923 (2010)
- Isayama H, "Covered biliary metal stent: which are worse: the concepts, current models, or insertion methods", Gastrointest Endosc, 73, pp.1329~1330 (2011)
- Kasher JA, "A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP", Gastrointest Endosc, 73, pp.1292~1297 (2011)
- Shimizu S, "Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction", J Gastroenterol Hepatol, 28, pp.68~72 (2013)
- Kawakubo K, "Risk factors for pancreatitis following transpapillary self-expandable metal stent placement", Surg Endosc, 26, pp.771~776 (2012)
- Isayama H, "Self-expandable metallic stent with high axial force is the risk factor of cholecystitis", Gastrointest Endosc, 75(4 Suppl), pp.AB380~ (2012)
- Mukai T, "Comparison of axial force and cell width of self-expandable metallic stents: which type of stent is better suited for hilar biliary strictures", J Hepatobiliary Pancreat Sci, 18, pp.646~652 (2011)