A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

Isayama, H.; Komatsu, Y.; Tsujino, T.; Scasahira, N.; Hirano, K.; Toda, N.; Nakai, Y.; Yamamoto, N.; Tada, M.; Yoshida, H.; Shiratori, Y.; Kawabe, T.; Omato, M.
May 2004
Gut;May2004, Vol. 53 Issue 5, p729
Academic Journal
Background and aim: Covered self-expandable metal stents (EMS) were recently developed to overcome tumour ingrowth in conventional EMS. However, supporting evidence for the efficacy of covered EMS is lacking. Patients and methods: We enrolled 112 patients with unresectable distal biliary malignancies. They were randomly assigned to polyurethane covered (n=57) or original diamond stent (n=55). Results: Stent occlusion occurred in eight patients (14%) after a mean of 304 days in the covered group, and in 21 patients (38%) after a mean of 166 days in the uncovered group. The incidence of covered EMS occlusion was significantly lower than that of uncovered EMS (p = 0.0032). The cumulative stent patency of covered stents was significantly higher than that of uncovered stents (p=0.0066). No tumour ingrowth occurred in the covered group while it was observed in 15 patients in the uncovered group. In subgroup analysis, the cumulative patency of the covered EMS was significantly higher in pancreatic cancer (p=0.0363) and metastatic lymph nodes (p=0.0354). There was no significant difference in survival between the two groups. Acute cholecystitis was observed in two of the covered group and in none of the uncovered group. Mild pancreatitis occurred in five of the covered group and in one of the uncovered group. Conclusions: Covered diamond stents successfully prevented tumour ingrowth and were significantly superior to uncovered stents for the treatment of patients with distal malignant biliary obstruction. However, careful attention must be paid to complications specific to covered self-expandable metal stents, such as acute cholecystitis and pancreatitis.


Related Articles

  • Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Liu, R. C.; Traverso, L. W. // Surgical Endoscopy;May2005, Vol. 19 Issue 5, p638 

    Background: Computed tomography (CT) is insensitive to small metastatic deposits in patients with pancreatic cancer. This study aimed to evaluate additional staging information obtained by laparoscopy in the subset of patients with locally extending pancreatic cancer but no evidence...

  • Indications and technique of central pancreatectomy-early and late results. Iacono, Calogero; Bortolasi, Luca; Serio, Giovanni // Langenbeck's Archives of Surgery;Jul2005, Vol. 390 Issue 3, p266 

    Background and aim: Central pancreatectomy (CP) is an operation that allows one to resect benign or low grade malignant tumours located in the pancreatic isthmus that are not suitable for enucleation. The main advantage of this operation compared with major resections is that it permits to spare...

  • Pancreatic Acinar Cell Carcinoma: A Multi-institutional Study. Matos, Jesus M.; Schmidt, C. Max; Turrini, Olivier; Agaram, Narasimhan P.; Niedergethmann, Marco; Saeger, Hans Detlev; Merchant, Nipun; Johnson, Cynthia S.; Lillemoe, Keith D.; Grützmann, Robert // Journal of Gastrointestinal Surgery;Aug2009, Vol. 13 Issue 8, p1495 

    Introduction The presentation and outcome of patients with acinar cell carcinoma (ACC) of the pancreas compared to the more common ductal cell adenocarcinoma (DCA) may be distinct. This study combines the experience with ACC from multiple academic institutions to better understand its natural...

  • Molecular epidemiologic features of inflammatory breast cancer: a comparison between Egyptian and US patients. An-Chi Lo; Celina Kleer; Mousumi Banerjee; Sherif Omar; Hussein Khaled; Saad Eissa; Ahmed Hablas; Julie Douglas; Sharon Alford; Sofia Merajver; Amr Soliman // Breast Cancer Research & Treatment;Nov2008, Vol. 112 Issue 1, p141 

    Abstract   Background Inflammatory breast cancer (IBC) is a lethal form of breast cancer with unknown etiology. A higher frequency of IBC and a more aggressive IBC phenotype was reported in Egypt than in the United States. This difference in disease frequency and presentation might be...

  • Smaller tumors at diagnosis improved pancreatic cancer survival.  // Hem/Onc Today;5/10/2008, Vol. 9 Issue 8, p40 

    The article reports that a retrospective study showed smaller tumors increased pancreatic cancer survival during diagnosis. It details the study of the University of Texas M.D. Anderson Cancer Center and Saint Louis University that included 65 consecutive pancreatic cancer patients who have...

  • Invasive carcinomas originating from intraductal papillary mucinous neoplasms of the pancreas: conspicuity and primary sites of the solid masses on triple-phase dynamic CT imaging. Yamada, Yasunari; Mori, Hiromu; Matsumoto, Shunro; Hijiya, Naoki; Hongo, Norio; Moriyama, Masatsugu // Abdominal Imaging;Apr2010, Vol. 35 Issue 2, p181 

    Objective: To assess the conspicuity of invasive carcinomas (solid masses) originating from pancreatic intraductal papillary mucinous neoplasms (invasive IPMNs) and the primary sites of the solid masses on thin-slice dynamic CT. Methods: Twenty patients with...

  • To Whipple or Not: Choices in Cancer Treatment. LAUGHTER, SAL; WELLBERY, CAROLINE // American Family Physician;10/1/2014, Vol. 90 Issue 7, p496 

    A personal narrative is presented which explores the author's experience of having a stage IV pancreatic cancer and being able to survive without having the Whipple procedure, a major abdominal surgery to remove tumorous parts of the pancreas.

  • The preoperative SUVmax is superior to ADCmin of the primary tumour as a predictor of disease recurrence and survival in patients with endometrial cancer. Nakamura, Keiichiro; Joja, Ikuo; Fukushima, Chikako; Haruma, Tomoko; Hayashi, Chiaki; Kusumoto, Tomoyuki; Seki, Noriko; Hongo, Atsushi; Hiramatsu, Yuji // European Journal of Nuclear Medicine & Molecular Imaging;Jan2013, Vol. 40 Issue 1, p52 

    Purpose: The purpose of this study was to investigate the prognostic value of the minimum apparent diffusion coefficient (ADCmin) derived from diffusion-weighted MR imaging and of the maximum standardized uptake value (SUVmax) derived from PET/CT imaging of the primary tumour in patients with...

  • Prognostic significance of expression of matrix metalloproteinase in colorectal adenocarcinomas and their metastases. V. Delektorskaya; A. Perevoshchikov; D. Golovkov; N. Kushlinskii // Bulletin of Experimental Biology & Medicine;Apr2007, Vol. 143 Issue 4, p455 

    Abstract  Expression of matrix metalloproteinases 2 and 9 was studied in primary tumors and their metastases in patients with colorectal cancer. The correlation of immunoreactivity with clinical morphological signs, prognosis of the disease, and development of metastases in the liver was...


Read the Article


Sign out of this library

Other Topics