Prolonged patency of fully covered self-expandable metal stents with an externally anchored plastic stent in distal malignant biliary obstruction

Abstract

Background Fully covered self-expandable metal stents (FCSEMSs) are widely used for endoscopic treatment of distal malignant biliary obstruction (dMBO). We aimed to assess the efficacy of anchoring an external plastic stent to an FCSEMS in dMBO.

Methods A multicenter retrospective cohort study was performed in patients with dMBO to compare stent patency between FCSEMSs and FCSEMSs with an externally anchored plastic stent (EPS). For external anchoring, a 7-Fr double-pigtail plastic stent (DPPS) was placed first in the bile duct, then an FCSEMS was deployed side-by-side.

Results Among a total of 185 patients, 65 had an FCSEMS alone and 120 had an FCSEMS with an EPS. The median stent patency was significantly longer in the FCSEMS with an EPS group than in the FCSEMS only group (342 vs. 240 days; P = 0.04). The rate of stent migration was significantly lower in the FCSEMS with an EPS group than in the FCSEMS only group (10.8 % vs. 27.7 %; P = 0.01). There were no significant differences in the rates of stent occlusion and adverse events between the two groups.

Conclusions A novel and simple technique of anchoring an external plastic stent may decrease the risk of FCSEMS migration and prolong stent patency, without significantly increasing the adverse events rate in dMBO.

^‡ Joint first authors

Publikationsverlauf

Eingereicht: 09. Juni 2022

Angenommen nach Revision: 23. November 2022

Artikel online veröffentlicht:
03. Februar 2023

• References

• 1 Committee ATA, Pfau PR, Pleskow DK. et al. Pancreatic and biliary stents. Gastrointest Endosc 2013; 77: 319-327
• 2 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50: 910-930
• 3 Boulay BR, Parepally M. Managing malignant biliary obstruction in pancreas cancer: choosing the appropriate strategy. World J Gastroenterol 2014; 20: 9345-9353
• 4 Li J, Li T, Sun P. et al. Covered versus uncovered self-expandable metal stents for managing malignant distal biliary obstruction: a meta-analysis. PLoS One 2016; 11: e0149066
• 5 Tringali A, Hassan C, Rota M. et al. Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy 2018; 50: 631-641
• 6 Nakai Y, Isayama H, Kogure H. et al. Risk factors for covered metallic stent migration in patients with distal malignant biliary obstruction due to pancreatic cancer. J Gastroenterol Hepatol 2014; 29: 1744-1749
• 7 Paik WH, Woo SM, Chun JW. et al. Efficacy of an internal anchoring plastic stent to prevent migration of a fully covered metal stent in malignant distal biliary strictures: a randomized controlled study. Endoscopy 2021; 53: 578-585
• 8 Chandrasekhara V, Khashab MA. ASGE Standards of Practice Committee. et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
• 9 Saleem A, Leggett CL, Murad MH. et al. 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 2011; 74: 321-327 e321-e323
• 10 Park DH, Lee SS, Lee TH. et al. 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 2011; 73: 64-70
• 11 Isayama H, Kawakubo K, Nakai Y. et al. A novel, fully covered laser-cut nitinol stent with antimigration properties for nonresectable distal malignant biliary obstruction: a multicenter feasibility study. Gut Liver 2013; 7: 725-730
• 12 Lee HW, Moon JH, Lee YN. et al. Usefulness of newly modified fully covered metallic stent of 12 mm in diameter and anti-migration feature for periampullary malignant biliary strictures: Comparison with conventional standard metal stent. J Gastroenterol Hepatol 2019; 34: 1208-1213
• 13 Katsinelos P, Lazaraki G, Gkagkalis S. et al. A fully covered self-expandable metal stent anchored by a 10-Fr double pigtail plastic stent: an effective anti-migration technique. Ann Gastroenterol 2017; 30: 114-117
• 14 Minaga K, Kitano M, Imai H. et al. Evaluation of anti-migration properties of biliary covered self-expandable metal stents. World J Gastroenterol 2016; 22: 6917-6924
• 15 Nakai Y, Isayama H, Mukai T. et al. Impact of anticancer treatment on recurrent obstruction in covered metallic stents for malignant biliary obstruction. J Gastroenterol 2013; 48: 1293-1299