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J Gastroenterol Hepatol. 2018 Mar;33(3):696-703. doi: 10.1111/jgh.13977.

Covered duodenal self-expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction.

Author information

1
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
2
Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
3
Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan.
4
Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
5
Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan.
6
Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan.
7
Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan.
8
Department of Gastroenterology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.

Abstract

BACKGROUND AND AIM:

Endoscopic biliary and duodenal stenting (DS; double stenting) is widely accepted as a palliation therapy for malignant bilioduodenal obstruction. The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS.

METHODS:

Patients who underwent DS from April 2004 to March 2017 were analyzed retrospectively with regard to clinical outcomes and predictive factors of recurrent biliary and duodenal obstruction (recurrent biliary obstruction [RBO] and recurrent duodenal obstruction [RDO]).

RESULTS:

A total of 109 consecutive patients was enrolled. Technical success of DS was achieved in 108 patients (99.1%). Symptoms due to biliary and duodenal obstruction were improved in 89 patients (81.7%). RBO occurred in 25 patients (22.9%) and RDO in 13 (11.9%). The median times to RBO and RDO from DS were 87 and 76 days, respectively. Placement of a duodenal uncovered self-expandable metal stent (U-SEMS) was significantly associated with RBO in the multivariable analysis (P = 0.007). Time to RBO was significantly longer in the duodenal covered self-expandable metal stent group than in the U-SEMS group (P = 0.003). No predictive factors of RDO were detected, and duodenal stent type was not associated with the time to RDO (P = 0.724).

CONCLUSIONS:

Double stenting was safe and effective for malignant bilioduodenal obstruction. Duodenal U-SEMS is a risk factor for RBO. The covered self-expandable metal stent is the preferred type of duodenal SEMS in patients with DS (Clinical trial registration number: UMIN000027606).

KEYWORDS:

bilioduodenal obstruction; double stenting; self-expandable metal stent

PMID:
28902972
DOI:
10.1111/jgh.13977
[Indexed for MEDLINE]

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