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A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures.

ABSTRACT: BACKGROUND AND STUDY AIMS?:Stent insertion at endoscopic retrograde cholangiopancreatography (ERCP) is an established therapy for managing malignant biliary obstruction. Conventional plastic stents with a tubular design are most commonly used despite limited patency. Plastic stents with a winged design may theoretically increase the duration of stent patency. The aim of this study was to compare stent patency of the winged versus conventional plastic stents in patients with malignant biliary obstruction. PATIENTS AND METHODS?:A prospective, randomized subject-blinded trial was conducted. Patients with malignant biliary obstruction were randomized (1:1) to either a 10 French winged stent or 7 or 10 French conventional plastic stent. Strictures greater than 1?cm distal to the hilum were included. Patients were followed clinically to determine the frequency of stent failure until surgery, death or study closure. RESULTS?:Fifty-eight patients were enrolled. Following 9 exclusions, 49 patients were randomized to a winged (n?=?23) or conventional stent (n?=?26). Median time to stent failure was 89 (95?% CI 26-NA) vs 143 (95?% CI 33?-?266) days ( P ?=?0.963) for the winged and conventional group, respectively. Stent failure for the winged group occurred in 11 (48?%) compared to 14 (54?%) in the conventional group.?Median survival was 123 (95?% CI 81?-?189) vs 342 days (95?% CI 123?-?704) (p?=?0.084) in the winged and conventional group respectively. There were no procedure related adverse events. CONCLUSIONS?:Improvement in stent patency was not seen with the winged stent when compared to the conventional plastic stent.

SUBMITTER: Ayres L

PROVIDER: S-EPMC5500122 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures.

Ayres Lachlan L Cheriyan Danny D Scott Ryan R Kim Edward E Lee Terry T Singer Joel J Donnellan Fergal F Byrne Michael M Weiss Alan A Enns Robert R Amar Jack J Lam Eric E Telford Jennifer J

Endoscopy international open 20170706 7

<h4>Background and study aims</h4>Stent insertion at endoscopic retrograde cholangiopancreatography (ERCP) is an established therapy for managing malignant biliary obstruction. Conventional plastic stents with a tubular design are most commonly used despite limited patency. Plastic stents with a winged design may theoretically increase the duration of stent patency. The aim of this study was to compare stent patency of the winged versus conventional plastic stents in patients with malignant bili ...[more]

PMID: 28691046

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Project description:BackgroundUreteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort.MethodsCancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated.ResultsA total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration.ConclusionsResonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage.

Dataset Information

A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures.

Publications

A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures.

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