Original Article: Clinical EndoscopyClinical outcomes of nitinol and stainless steel uncovered metal stents for malignant biliary strictures: is there a difference?
Section snippets
Methods
The study was approved by the M. D. Anderson Cancer Center Institutional Review Board. Review of all uncovered SEMSs placed between January 1, 2006, and October 31, 2007, was performed. The majority of the strictures in the study were located in the common ducts and not intrahepatic ducts; decision as to which stent was to be placed in any given situation was not randomized and was left to the discretion of the endoscopist considering the location and complexity of the strictures. The primary
Results
A total of 81 N and 96 SS uncovered metal stents were placed during the period. Six patients in the N group and 8 patients in the SS group had 2 (tandem or bilateral) uncovered metal stents placed. A summary of demographic data is provided in TABLE 1, TABLE 2. The most common cancer diagnosis was pancreatic cancer: 70.2% of all patients (80.2% in the N group and 62.5% in the SS group; P = .06). Hepatic metastases were present in 54.3% of the N group and 44.8% of the SS group (P = .21).
A summary
Discussion
Our results demonstrated no significant advantage of one stent over the other. Similar performance, as determined by duration of stent patency and stent occlusion rates, was seen. Given the distribution of our data, these findings would appear to apply mostly to pancreatic cancer patients with common bile duct strictures. Our results suggest that both stents are largely interchangeable for the management for these types of strictures. No clear survival benefit or improved performance (patency
Conclusion
Similar rates of performance and outcomes were achieved between N and SS stents regarding stent patency and occlusion rates, especially for the management of common bile duct strictures in patients with pancreatic cancer. However, the lack of a difference in clinical outcome between the 2 groups should be interpreted with the limitation of the small sample size. No perforations or fistulous complications were observed in patients undergoing chemoradiation for pancreatic cancer with metal stents
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Cited by (24)
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2018, ERCP, Third EditionBending behaviors of fully covered biodegradable polydioxanone biliary stent for human body by finite element method
2018, Journal of the Mechanical Behavior of Biomedical MaterialsCitation Excerpt :The common materials used for metal biliary stent includes nickel titanium alloy wire, stainless steel wire, tantalum wire and so on, which could guarantee enough supporting force without sacrificing the bending and compliance (Chun et al., 2010). Weston et al. (2010) and Yang et al. (2009) compared the clinical efficacy resulted by different material composition stent and found that there is no obvious difference in long-term patency and complication, but the metal stent structure has some influences on the clinical efficacy, Loew et al. (2009) analyzed the curative effect of “Zilver” and “Walstent” stent with different diameter, and obtained that “Zilver” stent with smaller diameter results in higher restricture rate. The metal biliary stents have advantage in long-term patency, low migration rate, improving life quality and decreasing therapy cost compared with plastic biliary stent (Lammer et al., 1996; Guo et al., 2001).
Aspirin Use Is Associated With Reduced Risk of Occlusion of Metallic Biliary Stents
2017, Clinical Gastroenterology and HepatologyCitation Excerpt :Endeavors to improve SEMS patency has largely focused on better stent design as a potential solution. Multiple studies comparing stent patency based on brand, design, and size produced mixed results with no clear benefit of one over the others.25–28 It is time to consider pharmacologic solutions to achieve the goal of better SEMS patency.
Pancreatic and biliary stents
2013, Gastrointestinal EndoscopyCitation Excerpt :The 10-mm Zilver stents and Wallstents had a similar percentage of stent occlusion, but the 6-mm Zilver stents had a significantly higher overall and significantly earlier occlusion rate.93 Two studies compared nitinol and stainless steel SEMSs and found no difference in efficacy, stent patency, or adverse events.94,95 One of these studies found that, on subgroup analysis, nitinol stents had a longer duration of stent patency for hilar tumors.95
Indications and Contraindications
2013, ERCP: Second Edition
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.