CardioVascular and Interventional Radiology

, Volume 42, Issue 2, pp 268–275 | Cite as

Study of Percutaneous Stent Placement with Iodine-125 Seed Strand for Malignant Biliary Obstruction

  • Wei-Zhong Zhou
  • Yong-Meng Fu
  • Zheng-Qiang YangEmail author
  • Hai-Bin Shi
  • Sheng Liu
  • Jin-Guo Xia
  • Chun-Gao Zhou
Clinical Investigation Non-Vascular Interventions
Part of the following topical collections:
  1. Non-Vascular Interventions



To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ).

Materials and Methods

This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated.


Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8–22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031).


SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.


Malignant obstructive jaundice Iodine-125 seed Self-expandable metallic stent Stent patency Survival 



This study was supported by the Six Talent Peaks Project in Jiangsu Province (CN) (No. 2013-WSN-038).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of ethical committee of the First Affiliated Hospital of Nanjing Medical University and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in this study.


  1. 1.
    Karnabatidis D, Spiliopoulos S, Katsakiori P, Romanos O, Katsanos K, Siablis D. Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction. World J Hepatol. 2013;5(3):114–9.CrossRefGoogle Scholar
  2. 2.
    Lorenz JM. Management of malignant biliary obstruction. Semin Intervent Radiol. 2016;33(4):259–67.CrossRefGoogle Scholar
  3. 3.
    Willingham FF. All wrapped up: metal biliary stents and the effect of stent coverings. Gastrointest Endosc. 2010;72(5):924–6.CrossRefGoogle Scholar
  4. 4.
    Kullman E, Frozanpor F, Soderlund C, Linder S, Sandstrom P, Lindhoff-Larsson A, et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 2010;72(5):915–23.CrossRefGoogle Scholar
  5. 5.
    Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53(5):729–34.CrossRefGoogle Scholar
  6. 6.
    Schoder M, Rossi P, Uflacker R, Bezzi M, Stadler A, Funovics MA, et al. Malignant biliary obstruction: treatment with ePTFE-FEP-covered endoprostheses initial technical and clinical experiences in a multicenter trial. Radiology. 2002;225(1):35–42.CrossRefGoogle Scholar
  7. 7.
    Krokidis M, Fanelli F, Orgera G, Tsetis D, Mouzas I, Bezzi M, et al. Percutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents. Cardiovasc Intervent Radiol. 2011;34(2):352–61.CrossRefGoogle Scholar
  8. 8.
    Chen Y, Wang XL, Yan ZP, Wang JH, Cheng JM, Gong GQ, et al. The use of (1)(2)(5)I seed strands for intraluminal brachytherapy of malignant obstructive jaundice. Cancer Biother Radiopharm. 2012;27(5):317–23.CrossRefGoogle Scholar
  9. 9.
    Hasimu A, Gu JP, Ji WZ, Zhang HX, Zhu DW, Ren WX. Comparative study of percutaneous transhepatic biliary stent placement with or without iodine-125 seeds for treating patients with malignant biliary obstruction. J Vasc Interv Radiol. 2017;28(4):583–93.CrossRefGoogle Scholar
  10. 10.
    Jiao D, Wu G, Ren J, Han X. Study of self-expandable metallic stent placement intraluminal (125)I seed strands brachytherapy of malignant biliary obstruction. Surg Endosc. 2017;31(12):4996–5005.CrossRefGoogle Scholar
  11. 11.
    Wang T, Liu S, Zheng YB, Song XP, Sun BL, Jiang WJ, et al. Clinical study on using (125)I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice. Anticancer Res. 2017;37(8):4649–53.Google Scholar
  12. 12.
    Zhang W, Yang ZQ, Shi HB, Liu S, Zhou WZ, Zhao LB. Placement of (1)(2)(5)I seed strands and stents for a type IV Klatskin tumor. World J Gastroenterol. 2015;21(1):373–6.CrossRefGoogle Scholar
  13. 13.
    Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.CrossRefGoogle Scholar
  14. 14.
    Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet (London, England). 1992;340(8834–8835):1488–92.CrossRefGoogle Scholar
  15. 15.
    Yang MJ, Kim JH, Yoo BM, Hwang JC, Yoo JH, Lee KS, et al. Partially covered versus uncovered self-expandable nitinol stents with anti-migration properties for the palliation of malignant distal biliary obstruction: a randomized controlled trial. Scand J Gastroenterol. 2015;50(12):1490–9.CrossRefGoogle Scholar
  16. 16.
    Isayama H, Nakai Y, Kogure H, Yamamoto N, Koike K. Biliary self-expandable metallic stent for unresectable malignant distal biliary obstruction: which is better: covered or uncovered? Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2013;25(Suppl 2):71–4.Google Scholar
  17. 17.
    Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011;74(2):321-7.e1-3.CrossRefGoogle Scholar
  18. 18.
    Niu L, Zhou L, Xu K, Mu F. Combination of cryosurgery and Iodine-125 seeds brachytherapy for lung cancer. J Thorac Dis. 2012;4(5):504–7.Google Scholar
  19. 19.
    Ko AL, Fink KR, Stelzer KM, Silbergeld DL. Safety and efficacy of concomitant chemotherapeutic wafers and iodine-125 seeds for recurrent glioblastoma. Surg Neurol Int. 2012;3:137.CrossRefGoogle Scholar
  20. 20.
    Xu K, Niu L, Mu F, Hu Y. Cryosurgery in combination with brachytherapy of iodine-125 seeds for pancreatic cancer. Gland Surg. 2013;2(2):91–9.Google Scholar
  21. 21.
    Zhu HD, Guo JH, Huang M, Ji JS, Xu H, Lu J, et al. Irradiation stents vs. conventional metal stents for unresectable malignant biliary obstruction: a multicenter trial. J Hepatol. 2018;68(5):970–7.CrossRefGoogle Scholar
  22. 22.
    Zhu HD, Guo JH, Zhu GY, He SC, Fang W, Deng G, et al. A novel biliary stent loaded with (125)I seeds in patients with malignant biliary obstruction: preliminary results versus a conventional biliary stent. J Hepatol. 2012;56(5):1104–11.CrossRefGoogle Scholar
  23. 23.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England: 1990). 2009;45(2):228–47.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Wei-Zhong Zhou
    • 1
  • Yong-Meng Fu
    • 1
  • Zheng-Qiang Yang
    • 1
    Email author
  • Hai-Bin Shi
    • 1
  • Sheng Liu
    • 1
  • Jin-Guo Xia
    • 1
  • Chun-Gao Zhou
    • 1
  1. 1.Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina

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