|
1
|
Moutzoukis M, Argyriou K, Kapsoritakis A, Christodoulou D. Endoscopic luminal stenting: Current applications and future perspectives. World J Gastrointest Endosc 2023; 15:195-215. [PMID: 37138934 PMCID: PMC10150289 DOI: 10.4253/wjge.v15.i4.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Endoscopic luminal stenting (ELS) represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract. Previous studies have shown that ELS can provide rapid relief of symptoms related to esophageal, gastric, small intestinal, colorectal, biliary, and pancreatic neoplastic strictures without compromising cancer patients’ overall safety. As a result, in both palliative and neoadjuvant settings, ELS has largely surpassed radiotherapy and surgery as a first-line treatment modality. Following the abovementioned success, the indications for ELS have gradually expanded. To date, ELS is widely used in clinical practice by well-trained endoscopists in managing a wide variety of diseases and complications, such as relieving non-neoplastic obstructions, sealing iatrogenic and non-iatrogenic perforations, closing fistulae and treating post-sphincterotomy bleeding. The abovementioned development would not have been achieved without corresponding advances and innovations in stent technology. However, the technological landscape changes rapidly, making clinicians’ adaptation to new technologies a real challenge. In our mini-review article, by systematically reviewing the relevant literature, we discuss current developments in ELS with regard to stent design, accessories, techniques, and applications, expanding the research basis that was set by previous studies and highlighting areas that need to be further investigated.
Collapse
Affiliation(s)
- Miltiadis Moutzoukis
- Department of Gastroenterology, University Hospital of Ioannina, Ioannina GR45333, Greece
| | - Konstantinos Argyriou
- Department of Gastroenterology, Medical School and University Hospital of Larissa, Larissa GR41334, Greece
| | - Andreas Kapsoritakis
- Department of Gastroenterology, Medical School and University Hospital of Larissa, Larissa GR41334, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina GR45500, Greece
| |
Collapse
|
|
2
|
Zhao X, Shi L, Wang J, Guo S, Zhu S. Clinical value of preferred endoscopic ultrasound-guided antegrade surgery in the treatment of extrahepatic bile duct malignant obstruction. Clinics (Sao Paulo) 2022; 77:100017. [PMID: 35294916 PMCID: PMC8918834 DOI: 10.1016/j.clinsp.2022.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To explore the clinical value of preferred ultrasound endoscopic guided biliary drainage in patients with extrahepatic biliary obstruction with intrahepatic biliary ectasis. METHODS A total of 58 patients with malignant obstruction and intrahepatic bile duct expansion, including 32 males, 26 females and median age 65 (58‒81) were selected. A prospective randomized controlled study was randomized into EUS-AG and ERCP-BD, with 28 patients in EUS-AG and 30 in ERCP-BD. The efficacy of the two treatments, operation success rate, operation time, the incidence of complications, hospitalization days, cost, unimpeded stent duration, and survival time were compared. RESULTS 1) The surgical success rate in group EUS-AG was 100%, and in group, ERCP-BD was 96.67%. There was no statistical difference in surgical success rate in the two groups (p>0.05). 2) Average operating time in EUS-AG was (23.69±11.57) min, and in ERCP-BD was (36.75±17.69) min. The difference between the two groups has statistical significance (p<0.05). 3) The clinical symptoms of successful patients were significantly relieved. Compared with the preoperative procedure, the differences in group levels had statistical significance (p<0.05); TBIL, ALP, WBC and CRP levels, no statistical significance difference in groups (p>0.05). CONCLUSION EUS-AG operation has short time, low incidence of complications, safe, effective, and can be used as the preferred treatment plan for patients with extrahepatic biliary duct malignant obstruction associated with intrahepatic biliary duct expansion; EUS-AG operation has more unique clinical advantages for patients with altered gastrointestinal anatomy or upper gastrointestinal obstruction.
Collapse
Affiliation(s)
- Xuan Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lihong Shi
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jinchen Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Siming Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Sumin Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| |
Collapse
|
|
3
|
O'Neill RS, Duong T, Dionela W, Rogge C, Brungs D. Pancreatitis and Biliary Obstruction Secondary to Duodenal Metastasis from Rapidly Progressing Lung Adenocarcinoma Treated with Common Bile Duct Stenting. Case Rep Oncol 2020; 13:962-967. [PMID: 32999656 PMCID: PMC7506373 DOI: 10.1159/000508745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is characterised by diffuse metastases, with common sites being the brain, liver, bones, and adrenal glands. Small bowel metastasis from NSCLC is a rare phenomenon, particularly in patients with an adenocarcinoma histology. We report the case of a 56-year-old lung adenocarcinoma patient with a duodenal metastasis diagnosed on FDG/PET-CT and confirmed on duodenal biopsy. Although initially asymptomatic, he subsequently presented with obstructive jaundice secondary to rapid local disease progression at the duodenal metastasis, requiring endoscopic intervention for biliary drainage. He was commenced on single agent pembrolizumab, with disease response on subsequent follow-up. This case highlights a rare case of gastrointestinal metastasis from NSCLC requiring endoscopic intervention due to rapid progression of the disease at the site of metastasis.
Collapse
Affiliation(s)
- Robert Sean O'Neill
- Department of Oncology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Tuan Duong
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Welan Dionela
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Claudia Rogge
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Daniel Brungs
- Department of Oncology, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
|
4
|
Zu QQ, Zhang JX, Wang B, Ye W, Liu S, Shi HB. Percutaneous transpapillary biliary stent placement for distal malignant biliary obstruction: Outcomes and survival analysis. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:714-721. [PMID: 31418416 DOI: 10.5152/tjg.2019.18317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS For distal malignant biliary obstruction (MBO), a percutaneous metal stent is usually inserted by the transpapillary method. However, stent-related complications and recurrent biliary obstruction following transpapillary stent placement are concerns, and survival analysis of patients with distal MBO has rarely been done. MATERIALS AND METHODS From January 2012 to March 2016, 104 patients underwent transpapillary uncovered metal stent placement for distal MBO at our institution. Clinical success, complications, recurrent biliary obstruction rates, and predictors of survival were analyzed. RESULTS Of the total 104 patients, clinical success after stent insertion was achieved in 93 patients (90.3%). Major complications were observed in 24 patients (23.1%), which were as follows: cholangitis in 19 patients; pancreatitis in four patients; and biloma in one patient. Recurrent biliary occlusion was observed in 28 patients (26.9%). The median overall survival period was 162 days. The 3-, 6-, and 12-month overall survival rates after stent insertion were 64.4%, 41.3%, and 10.6%, respectively. Results of multivariate analysis indicated that metastatic carcinoma compared with ampullary carcinoma (HR=3.82; 95% CI, 1.30-11.24; p=0.015) and longer biliary stricture (HR=1.04; 95% CI, 1.02-1.06; p<0.001) were independent risk factors for worse survival after metal stent insertion. CONCLUSION Transpapillary stent placement was found to be effective with acceptable complication rates for treating distal MBO. Primary tumor and length of biliary stricture were found to be statistically significant independent prognostic factors for survival.
Collapse
Affiliation(s)
- Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Bin Wang
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wei Ye
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| |
Collapse
|
|
5
|
Jin Z, Wei Y, Lin H, Yang J, Jin H, Shen S, Zhang X. Endoscopic ultrasound-guided versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta-analysis. Dig Endosc 2020; 32:16-26. [PMID: 31165527 DOI: 10.1111/den.13456] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Current evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as primary treatment for distal malignant biliary obstruction (MBO) is limited. We conducted a meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of distal MBO. METHODS We searched several databases for comparative studies evaluating EUS-BD vs. ERCP-BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival. RESULTS Four studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [RR] 1.00; 95% confidence interval [95% CI] 0.93-1.08), clinical success (RR 1.00; 95% CI 0.94-1.06) and total adverse events (RR 0.68; 95% CI: 0.31-1.48) between the two procedures. EUS-BD was associated with lower rates of post-procedure pancreatitis (RR 0.12; 95% CI 0.02-0.62), stent dysfunction (RR 0.54; 95% CI 0.32-0.91), and tumor in/overgrowth (RR 0.22; 95% CI 0.07-0.76). No differences were noted in reinterventions (RR 0.59; 95% CI 0.21-1.69), procedure duration (weighted mean difference -2.11; 95% CI -9.51 to 5.29), stent patency (hazard ratio [HR] 0.61; 95% CI 0.34-1.11), and overall survival (HR 1.00; 95% CI 0.66-1.51). CONCLUSIONS With adequate endoscopy expertise, EUS-BD could show similar efficacy and safety when compared with ERCP-BD for primary palliation of distal MBO and exhibits several clinical advantages.
Collapse
Affiliation(s)
- Zheng Jin
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaping Wei
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huapeng Lin
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Yang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hangbin Jin
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sisi Shen
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Zhang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
|
6
|
Li DF, Zhou CH, Wang LS, Yao J, Zou DW. Is ERCP-BD or EUS-BD the preferred decompression modality for malignant distal biliary obstruction? A meta-analysis of randomized controlled trials. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:953-960. [DOI: 10.17235/reed.2019.6125/2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
|
7
|
Park JK, Woo YS, Noh DH, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 2018; 88:277-282. [PMID: 29605722 DOI: 10.1016/j.gie.2018.03.015] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS ERCP-guided biliary drainage (ERCP-BD) is a criterion standard treatment for malignant biliary obstruction when curative surgery is not an option. Alternative methods such as percutaneous transhepatic biliary drainage would significantly lower the quality of life. EUS-guided biliary drainage (EUS-BD) has been developed and performed by experienced endoscopists. Therefore, the aims of this study were to evaluate the efficacy and safety of EUS-BD compared with ERCP in malignant biliary obstruction. METHODS The prospective randomized controlled study was conducted, and 30 patients were enrolled: 15 for each EUS-BD and ERCP-BD arms. The technical success, procedural time, clinical success, and adverse events were evaluated. RESULTS Thirty patients had extrahepatic malignant biliary tract obstruction (19 men, 11 women). Twenty-seven patients had unresectable pancreatic ductal adenocarcinomas, 1 patient had distal common bile duct cancer, and 2 patients had metastatic malignant lymphadenopathy. There were no significant differences both in terms of technical success rate and clinical success rate (100% vs 93% and 93% vs 100% in ERCP-BD vs EUS-BD, respectively; P = 1.00, P = 1.00). Four patients (31%) had tumor ingrowth-caused stent dysfunction in the ERCP-BD group, whereas 2 patients had food impaction and 2 patients had stent migration in the EUS-BD group. No significant procedure-related adverse events occurred in either group. CONCLUSIONS This prospective randomized controlled study suggests that EUS-BD has similar safety to ERCP-BD. EUS-BD was not superior to ERCP-BD in terms of relief of malignant biliary obstruction. EUS-BD may have fewer cases of tumor ingrowth but may also have more cases of food impaction or stent migration. (Clinical trial registration number: NCT01421836.).
Collapse
Affiliation(s)
- Joo Kyung Park
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sik Woo
- Division of Gastroenterology, Department of Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hyo Noh
- Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ju-Il Yang
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Bae
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwan Sic Yun
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Kyun Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Taek Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
|
8
|
Lee JJ, Hyun JJ, Choe JW, Lee DW, Kim SY, Jung SW, Jung YK, Koo JS, Yim HJ, Lee SW. Endoscopic biliary stent insertion through specialized duodenal stent for combined malignant biliary and duodenal obstruction facilitated by stent or PTBD guidance. Scand J Gastroenterol 2017; 52:1258-1262. [PMID: 28685637 DOI: 10.1080/00365521.2017.1349833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Endoscopic stenting for combined malignant biliary and duodenal obstruction is technically demanding. However, this procedure can be facilitated when there is guidance from previously inserted stent or PTBD tube. This study aimed to evaluate the feasibility and clinical success rate of endoscopic placement of biliary self-expandable metal stent (SEMS) through duodenal SEMS in patients with combined biliary and duodenal obstruction due to inoperable or metastatic periampullary malignancy. MATERIALS AND METHODS A total of 12 patients with combined malignant biliary and duodenal stricture underwent insertion of biliary SEMS through the mesh of specialized duodenal SEMS from July 2012 to October 2016. Technical and clinical success rate, adverse events and survival after completion of SEMS insertion were evaluated. RESULTS The duodenal strictures were located in the first portion of the duodenum in four patients (Type I), in the second portion in three patients (Type II), and in the third portion in five patients (Type III). Technical success rate of combined metallic stenting was 91.7%. Insertion of biliary SEMS was guided by previously inserted biliary SEMS in nine patients, plastic stent in one patient, and PTBD in two patients. Clinical success rate was 90.9%. There were no early adverse events after the procedure. Mean survival period after combined metallic stenting was 91.9 days (range: 15-245 days). CONCLUSIONS Endoscopic placement of biliary SEMS through duodenal SEMS is feasible with high success rates and relatively easy when there is guidance. This method can be a good alternative for palliation in patients with combined biliary and duodenal obstruction.
Collapse
Affiliation(s)
- Jong Jin Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Jong Jin Hyun
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Jung Wan Choe
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Dong-Won Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Seung Young Kim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Sung Woo Jung
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Young Kul Jung
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Ja Seol Koo
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Hyung Joon Yim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| | - Sang Woo Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea
| |
Collapse
|
|
9
|
Ma KW, Chan ACY, She WH, Chok KSH, Dai WC, Tsang S, Cheung TT, Lo CM. Efficacy of endoscopic self-expandable metal stent placement versus surgical bypass for inoperable pancreatic cancer-related malignant biliary obstruction: a propensity score-matched analysis. Surg Endosc 2017; 32:971-976. [PMID: 28779260 DOI: 10.1007/s00464-017-5774-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
|
|
10
|
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing, self-expandable fully covered metal stent for palliative biliary drainage. Clin J Gastroenterol 2016; 9:79-85. [DOI: 10.1007/s12328-016-0634-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
|
|
11
|
The Choice of Palliative Treatment for Biliary and Duodenal Obstruction in Patients With Unresectable Pancreatic Cancer: Is Surgery Bypass Better? Int Surg 2016. [DOI: 10.9738/intsurg-d-14-00247.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the clinical significance of palliative operation for carcinoma of pancreas between bypass surgery and interventional therapy. Most patients with locally advanced pancreatic cancer cannot undergo resection and show obstructive jaundice at presentation. Methods of palliation in these patients comprise biliary stent or surgical bypass. We retrospectively analyzed the clinical data of 53 patients who underwent palliative treatment with incurable locally advanced pancreatic ductal adenocarcinoma. This retrospective study compared morbidity, mortality, hospital stay, readmission rate, and survival in these patients. A total of 31 patients underwent biliary bypass surgery, and 22 had interventional therapy. There was no significant difference in the patients' basic condition before operation and in the 30-day mortality between surgical palliation and intervention. However, there were some differences in the early complications, survival time, successful biliary drainage, and recurrent jaundice. Through analysis of these clinical data and the published studies, we conclude that surgical bypass is a better effective palliative method for patients than biliary and duodenum stent with locally advanced pancreatic cancer. Patients need to be carefully selected in consideration of operative risk and perceived overall survival.
Collapse
|
|
12
|
Abstract
Endoscopic stenting is increasingly being used in the management of gastrointestinal luminal obstruction, and has become the current treatment of choice for the palliation of blockage caused by malignant or benign growths. A variety of stents have been developed to enhance the efficacy of the procedure, and improvements are ongoing. In this article, we review the history of, and recent advances in, gastrointestinal stenting. We describe the rationale behind the design as well as the resulting outcome for each stent type.
Collapse
Affiliation(s)
- Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seok Jeong
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea
| | - Don Haeng Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea. ; Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea
| |
Collapse
|
|
13
|
Park JS, Jeong S, Lee DH. Recent Advances in Gastrointestinal Stent Development. Clin Endosc 2015; 48:209-15. [PMID: 26064820 PMCID: PMC4461664 DOI: 10.5946/ce.2015.48.3.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/06/2015] [Indexed: 12/17/2022] Open
Abstract
Endoscopic stenting is increasingly being used in the management of gastrointestinal luminal obstruction, and has become the current treatment of choice for the palliation of blockage caused by malignant or benign growths. A variety of stents have been developed to enhance the efficacy of the procedure, and improvements are ongoing. In this article, we review the history of, and recent advances in, gastrointestinal stenting. We describe the rationale behind the design as well as the resulting outcome for each stent type.
Collapse
Affiliation(s)
- Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seok Jeong
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea
| | - Don Haeng Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea. ; Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea
| |
Collapse
|
|
14
|
Dhir V, Itoi T, Khashab MA, Park DH, Yuen Bun Teoh A, Attam R, Messallam A, Varadarajulu S, Maydeo A. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc 2015; 81:913-23. [PMID: 25484326 DOI: 10.1016/j.gie.2014.09.054] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND A single session of EUS-guided biliary drainage (EUS-BD) may be a viable alternative to ERCP in patients with malignant distal common bile duct (CBD) obstruction. There is no study comparing EUS-BD and ERCP for the relief of distal malignant biliary obstruction. OBJECTIVE To compare the outcomes of self-expandable metal stent (SEMS) placement for malignant distal biliary obstruction by using ERCP and EUS-BD. STUDY DESIGN Multicenter, retrospective analysis. SETTING Tertiary referral centers. PATIENTS Patients with malignant distal CBD obstruction requiring SEMS placement. INTERVENTIONS Patients in the EUS-BD group underwent EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade (EUS-AG) procedures after 1 or more failed ERCP attempts. Patients in the ERCP group underwent retrograde SEMS placement. MAIN OUTCOME MEASUREMENTS Composite success (the ability to complete the intended therapeutic procedure in a single session and resulting in a greater than 50% decrease in bilirubin over 2 weeks). RESULTS The study included 208 patients, 104 treated with ERCP and 104 treated with EUS-BD (68 EUS-CDS, 36 EUS-AG). SEMS placement was successful in 98 patients in the ERCP group and 97 in the EUS-BD group (94.23% vs 93.26%, P = 1.00). The frequency of adverse events in the ERCP and EUS-BD groups was 8.65% and 8.65%, respectively. Postprocedure pancreatitis rates were higher in the ERCP group (4.8% vs 0, P = .059). The mean procedure times in the ERCP and EUS-BD groups were similar (30.10 and 35.95 minutes, P = .05). LIMITATIONS Retrospective analysis. CONCLUSIONS In patients with malignant distal CBD obstruction requiring SEMS placement, the short-term outcome of EUS-BD is comparable to that of ERCP.
Collapse
Affiliation(s)
- Vinay Dhir
- Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Do Hyun Park
- Department of Gastroenterology and Hepatology, Asan Medical Centre, Seoul, South Korea
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rajeev Attam
- Department of Gastroenterology and Hepatology, University of Minnesota Medical Centre, Minneapolis, Minnesota, USA
| | - Ahmed Messallam
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Amit Maydeo
- Department of Endoscopy and Endosonography, Baldota Institute of Digestive Sciences, Mumbai, India
| |
Collapse
|
|
15
|
Abstract
Malignant biliary obstruction, duodenal, and gastric outlet obstruction, and tumor-related pain are the complications of unresectable pancreatic adenocarcinoma that most frequently require palliative intervention. Surgery involving biliary bypass with or without gastrojejunostomy was once the mainstay of treatment in these patients. However, advances in non-operative techniques-most notably the widespread availability of endoscopic biliary and duodenal stents-have shifted the paradigm of treatment away from traditional surgical management. Questions regarding the efficacy and durability of endoscopic stents for biliary and gastric outlet obstruction are reviewed and demonstrate high rates of therapeutic success, low rates of morbidity, and decreased cost. Surgery remains an effective treatment modality, and still produces the most durable relief in appropriately selected patients.
Collapse
Affiliation(s)
- Alexander Stark
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - O Joe Hines
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| |
Collapse
|
|
16
|
Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: time to revisit our therapeutic options? J Clin Gastroenterol 2013; 47:695-9. [PMID: 23442836 DOI: 10.1097/mcg.0b013e31827fd311] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS. AIM : To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS. PATIENTS AND METHODS Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications. RESULTS A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as follows: postsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)]. CONCLUSIONS FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.
Collapse
|
|
17
|
Krokidis M, Hatzidakis A. Percutaneous Minimally Invasive Treatment of Malignant Biliary Strictures: Current Status. Cardiovasc Intervent Radiol 2013; 37:316-23. [DOI: 10.1007/s00270-013-0693-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023]
|
|
18
|
Ramesh H. Palliation of jaundice in pancreatic cancer: stent or surgery? Indian J Gastroenterol 2013; 32:80-1. [PMID: 23504476 DOI: 10.1007/s12664-013-0317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 02/04/2023]
|
|
19
|
Aggarwal R, Patel FD, Kapoor R, Kang M, Kumar P, Chander Sharma S. Evaluation of high-dose-rate intraluminal brachytherapy by percutaneous transhepatic biliary drainage in the palliative management of malignant biliary obstruction--a pilot study. Brachytherapy 2012. [PMID: 23186613 DOI: 10.1016/j.brachy.2012.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the role of high-dose-rate intraluminal brachytherapy (ILBT) through percutaneous transhepatic biliary drainage (PTBD) in patients with malignant biliary obstruction, in terms of improvement in symptoms, quality of life (QOL), and survival. METHODS AND MATERIALS From August 2004 to October 2006, 18 patients aged 30-70 years, who were found unsuitable for surgical resection or were inoperable because of poor general condition, were taken up for palliative ILBT through PTBD. All patients underwent PTBD followed by internal-external drainage. After a gap of 1 week, high-dose-rate ILBT was performed by delivering a dose of 800cGy prescribed at 1cm from the central axis of the catheter. Two such sessions were given 1 week apart. RESULTS The mean fall in bilirubin was 11.37mg% after PTBD and further 2.94mg% after ILBT. The overall response rates were 100% and 80% for pruritus and icterus, respectively. Improvement in appetite and weight gain was seen in 93.3% and 86.7% patients, respectively, at last followup. The median followup and survival duration were 7.3 and 8.27 months, respectively. Actuarial survival at 6 months was 61.11%. Treatment-related major complications were not seen in any of the patients. QOL showed significant improvement in global health status and most functional and symptom scales. CONCLUSIONS This prospective pilot study demonstrated that PTBD followed by ILBT is a feasible procedure with good symptom control, definite impact on QOL, and minimal complications in such patients. A prospective randomized study is required to more accurately assess the benefit of ILBT compared with biliary drainage alone.
Collapse
Affiliation(s)
- Rupali Aggarwal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | | | |
Collapse
|
|
20
|
Iwasaki Y, Kubota K, Kita J, Katoh M, Shimoda M, Sawada T, Iso Y. Single-stage intraoperative transhepatic biliary stenting in patients with unresectable hepatobiliary pancreatic tumors. Surg Endosc 2012; 27:505-13. [DOI: 10.1007/s00464-012-2469-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 06/11/2012] [Indexed: 01/18/2023]
|
|
21
|
Ridtitid W, Rerknimitr R. Management of an occluded biliary metallic stent. World J Gastrointest Endosc 2012; 4:157-61. [PMID: 22624066 PMCID: PMC3355237 DOI: 10.4253/wjge.v4.i5.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/15/2011] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.
Collapse
Affiliation(s)
- Wiriyaporn Ridtitid
- Wiriyaporn Ridtitid, Rungsun Rerknimitr, Director of Endoscopy Unit, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | |
Collapse
|
|
22
|
Karapanos K, Nomikos IN. Current surgical aspects of palliative treatment for unresectable pancreatic cancer. Cancers (Basel) 2011; 3:636-51. [PMID: 24212633 PMCID: PMC3756381 DOI: 10.3390/cancers3010636] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/19/2011] [Accepted: 02/05/2011] [Indexed: 02/06/2023] Open
Abstract
Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.
Collapse
Affiliation(s)
- Konstantinos Karapanos
- Department of Surgery (B′ Unit), “METAXA” Cancer Memorial Hospital, Piraeus, Greece; E-Mail:
| | - Iakovos N. Nomikos
- Department of Surgery (B′ Unit), “METAXA” Cancer Memorial Hospital, Piraeus, Greece; E-Mail:
| |
Collapse
|
|
23
|
Abstract
The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications.
Collapse
Affiliation(s)
- Sung-Gwon Kang
- Department of Interventional Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
|
24
|
Cho JH, Jeon TJ, Park JY, Kim HM, Kim YJ, Park SW, Chung JB, Song SY, Bang S. Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. Surg Endosc 2010; 25:475-82. [PMID: 20602138 DOI: 10.1007/s00464-010-1196-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/14/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction. METHODS Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as "stent-in-stent" at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncovered-covered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncovered-plastic). RESULTS The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p=0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR=2.04, CI=1.08-3.86) and survival time (HR=2.37, CI=1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR=0.27, CI=0.08-0.98) and survival (HR=0.17, CI=0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR=0.50, CI=0.26-0.99). CONCLUSIONS The placement of additional biliary stents using the "stent-in-stent" method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.
Collapse
Affiliation(s)
- Jae Hee Cho
- Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, and Sanggye Paik Hospital, 250 Seongsanno (134 Sinchon-Dong), Seodaemun-Ku, 120-752, Seoul, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|