Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 285-296
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.285
Optimization of biliary drainage in inoperable distal malignant strictures
Esam Elshimi, Wesam Morad, Omar Elshaarawy, Ahmed Attia
Esam Elshimi, Omar Elshaarawy, Ahmed Attia, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebine Elkom 32111, Egypt
Wesam Morad, Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia University, Shebine Elkom 32111, Egypt
Author contributions: Elshimi E, Elshaarawy O and Attia A collected the data and revised the manuscript; Morad W performed the statistical analysis; all authors wrote the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University (IRB number IRB00003413) in April 2015. A consent form was signed by every patient.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interests for all authors.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Esam Elshimi, MBChB, MD, MSc, Doctor, Professor, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Yassin Abdelghaffar Street, Shebine Elkom 32111, Egypt. eelshimi@liver-eg.org
Received: April 9, 2020
Peer-review started: April 9, 2020
First decision: May 26, 2020
Revised: June 3, 2020
Accepted: July 26, 2020
Article in press: July 26, 2020
Published online: September 16, 2020
Processing time: 153 Days and 12.3 Hours
ARTICLE HIGHLIGHTS
Research background

Most patients with malignant obstructive jaundice present at the unresectable stage, when the management is restricted only to palliative measures. The common causes of distal malignant biliary strictures are cancer of the head of the pancreas and extrahepatic cholangiocarcinoma. This is mostly treated with metal stent insertion placement for biliary drainage.

Research motivation

Many types of metal stents are commercially available, including covered and uncovered stents. However, it is still questionable which type of stent is more suitable for drainage, and half covered metal stents have been recently introduced.

Research objectives

To study the adverse effects and functionality of the recently introduced half covered metal stents vs fully covered and uncovered ones.

Research methods

We studied 210 patients and randomized them into three equal groups to investigate the functionality and performance of the three different types of metal stents which are the newly introduced half covered vs fully and uncovered metal stents.

Research results

The half covered metal stents showed no significant difference in the incidence of occlusion while significantly less incidence of migration than uncovered stents. In addition, the half covered stents showed significantly more functioning and patency time.

Research conclusions

The use of half covered metal stent is preferred over the use of uncovered metal stent and fully covered metal stent for optimizing biliary drainage in patients with distal inoperable malignant biliary obstruction.

Research perspectives

Our findings will appeal to endoscopists and promote the use of half covered metal stents for biliary drainage of malignant obstructive jaundice because of the decrease in adverse events and migration and the increase in functioning time.