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Covered Metal Stenting

  • Nabi Zaheer
  • D. Nageshwar Reddy
  • Sundeep Lakhtakia
Chapter

Abstract

Endoscopic biliary drainage is the mainstay of treatment for benign or malignant biliary obstruction. Endoprostheses for biliary drainage include plastic and metal stents. Uncovered metal stents are superior to plastic stents in terms of patency. However, tissue ingrowth and stent dysfunction are common through their bare wire mesh. Covered metal stents have been developed to overcome tissue ingrowth and prolong stent patency. Easy removability of covered metal stents makes them an attractive option for benign biliary obstructions. However, migration is an important drawback with covered stents. Currently available covered metal stents differ according to their structure, stent and covering material and mechanical properties. A number of studies have demonstrated their efficacy in benign as well as malignant biliary strictures. The safety, efficacy and ease of removability of covered metal stents have encouraged their use in non-stricture benign biliary diseases like bile leaks, perforation, bile duct stones and bleeding. The “battle of superiority” between covered and uncovered metal stents continues with contrasting results in recent studies. The choice of covered or uncovered metal stents should be individualized to the needs of each patient. Recent developments in covered metal stents include different antimigration designs, antireflux properties and drug-eluting capabilities.

Keywords

Covered metal stents Benign biliary strictures Malignant biliary obstruction 

References

  1. 1.
    Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57(2):178–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47(1):1–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Sawas T, Al Halabi S, Parsi MA, et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc. 2015;82(2):256–67.CrossRefPubMedGoogle Scholar
  4. 4.
    Carrasco CH, Wallace S, Charnsangavej C, Richli W, Wright KC, Fanning T, Gianturco C. Expandable biliary endoprosthesis: an experimental study. AJR Am J Roentgenol. 1985;145(6):1279–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Silvis SE, Sievert CE Jr, Vennes JA, et al. Comparison of covered versus uncovered wire mesh stents in the canine biliary tract. Gastrointest Endosc. 1994;40(1):17–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Alvarado R, Palmaz JC, Garcia OJ, et al. Evaluation of polymer-coated balloon-expandable stents in bile ducts. Radiology. 1989;170(3 Pt 2):975–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Soderlund C, Linder S, Bergenzaun PE, et al. Nitinol versus steel partially covered self-expandable metal stent for malignant distal biliary obstruction: a randomized trial. Endoscopy. 2014;46(11):941–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Isayama H, Mukai T, Itoi T, et al. Comparison of partially covered nitinol stents with partially covered stainless stents as a historical control in a multicenter study of distal malignant biliary obstruction: the WATCH study. Gastrointest Endosc. 2012;76(1):84–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Isayama H, Nakai Y, Toyokawa Y, et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc. 2009;70(1):37–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Isayama H, Nakai Y, Kawakubo K, et al. Covered metallic stenting for malignant distal biliary obstruction: clinical results according to stent type. J Hepatobil Pancreat Sci. 2011;18(5):673–7.CrossRefGoogle Scholar
  11. 11.
    Yasumori K, Mahmoudi N, Wright KC, et al. Placement of covered self-expanding metallic stents in the common bile duct: a feasibility study. J Vasc Interv Radiol. 1993;4(6):773–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Pavlova M, Doraganova M. Hydrolytic stability of polyurethane medical adhesive dressing. Biomaterials. 1994;15:59–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Bang BW, Jeong S, Lee DH, et al. The biodurability of covering materials for metallic stents in a bile flow phantom. Dig Dis Sci. 2012;57(4):1056–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim DH, Kang SG, Choi JR, et al. Evaluation of the biodurability of polyurethane-covered stent using a flow phantom. Korean J Radiol. 2001;2(2):75–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rossi P, Bezzi M, Salvatori FM, et al. Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up. Cardiovasc Intervent Radiol. 1997;20:441–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Severini A, Mantero S, Tanzi MC, et al. In vivo study of polyurethane-coated Gianturco-Rosch biliary Z-stents. Cardiovasc Intervent Radiol. 1999;22(6):510–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Isayama H, Komatsu Y, Tsujino T, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Poley JW, et al. A prospective group sequential study evaluating a new type of fully covered self-expandable metal stent for the treatment of benign biliary strictures. Gastrointest Endosc. 2012;75(4):783–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Catalano M, Linder J, George S, et al. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest Endosc. 2004;60:945–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Costamagna G, Pandolfi M, Mutignani M, et al. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc. 2001;54:162–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Draganov P, Hoffman B, Marsh W, et al. Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest Endosc. 2002;55(6):680.CrossRefPubMedGoogle Scholar
  22. 22.
    Cote GA, Xu H, Slivka A, et al. Fully covered metallic stents achieve comparable efficacy in a shorter time to plastic stents for the first-line endoscopic treatment of benign biliary strictures: interim results of a multicenter, randomized, controlled trial. Gastrointest Endosc. 2015;81(5S):AB194.CrossRefGoogle Scholar
  23. 23.
    Devière J, Nageshwar Reddy D, Püspök A, et al. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Gastroenterology. 2014;147(2):385–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Kahaleh M, Brijbassie A, Sethi A, et al. 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(8):695–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Haapamäki C, Kylänpää L, Udd M, et al. Randomized multicenter study of multiple plastic stents vs. covered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis. Endoscopy. 2015;47(7):605–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Kaffes A, Griffin S, Vaughan R, et al. A randomized trial of a fully covered self expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol. 2014;7(2):64–71.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kao D, Zepeda-Gomez S, Tandon P, et al. Managing the post liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review. Gastrointest Endosc. 2013;77(5):679–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Siiki A, Helminen M, Sand J, et al. Covered self-expanding metal stents may be preferable to plastic stents in the treatment of chronic pancreatitis-related biliary strictures: a systematic review comparing 2 methods of stent therapy in benign biliary strictures. J Clin Gastroenterol. 2014;48(7):635–43.CrossRefPubMedGoogle Scholar
  29. 29.
    Tarantino I, Mangiavillano B, Di Mitri R, et al. Fully covered self-expandable metallic stents in benign biliary strictures: a multicenter study on efficacy and safety. Endoscopy. 2012;44(10):923–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Park D, Lee S, Lee T, et al. Anchoring flap versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study. Gastrointest Endosc. 2011;73:64–70.CrossRefPubMedGoogle Scholar
  31. 31.
    Kahaleh M, Behm B, Clarke BW, et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? Gastrointest Endosc. 2008;67(3):446–54.CrossRefPubMedGoogle Scholar
  32. 32.
    Mahajan A, Ho H, Sauer B, et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation. Gastrointest Endosc. 2009;70(2):303–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Walter D, Laleman W, Jansen JM, et al. A fully covered self-expandable metal stent with antimigration features for benign biliary strictures: a prospective, multicenter cohort study. Gastrointest Endosc. 2015;81(5):1197–203.CrossRefPubMedGoogle Scholar
  34. 34.
    Irani S, Baron TH, Akbar A, et al. Endoscopic treatment of benign biliary strictures using covered self-expandable metal stents (CSEMS). Dig Dis Sci. 2014;59(1):152–60.CrossRefPubMedGoogle Scholar
  35. 35.
    Tarantino I, Barresi L, Curcio G, et al. Definitive outcomes of self-expandable metal stents in patients with refractory post-transplant biliary anastomotic stenosis. Dig Liver Dis. 2015;pii:S1590-8658(15)00226-1.Google Scholar
  36. 36.
    Cerecedo-Rodriguez J, Phillips M, Figueroa-Barojas P, et al. Self expandable metal stents for anastomotic stricture following liver transplant. Dig Dis Sci. 2013;58(9):2661–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Saxena P, Diehl DL, Kumbhari V, et al. A US multicenter study of safety and efficacy of fully covered self-expandable metallic stents in benign extrahepatic biliary strictures. Dig Dis Sci. 2015;60:3442–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Itoi T, Yasuda I, Doi S, et al. Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding. Endoscopy. 2011;43(4):369–72.CrossRefPubMedGoogle Scholar
  39. 39.
    Shah JN, Marson F, Binmoeller KF. Temporary self-expandable metal stent placement for treatment of post-sphincterotomy bleeding. Gastrointest Endosc. 2010;72(6):1274–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Valats J, Funakoshi N, Bauret P, et al. Covered self-expandable biliary stents for the treatment of bleeding after ERCP. Gastrointest Endosc. 2013;78(1):183–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Irani S, Baron TH, Law R, et al. Endoscopic treatment of nonstricture-related benign biliary diseases using covered self-expandable metal stents. Endoscopy. 2015;47(4):315–21.PubMedGoogle Scholar
  42. 42.
    Canena J, Liberato M, Meireles L, et al. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents. Gastrointest Endosc. 2015;82(1):70–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Cerefice M, Sauer B, Javaid M, et al. Complex biliary stones: treatment with removable self expandable metal stents: a new approach (with videos). Gastrointest Endosc. 2011;74(3):520–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Jun CH, Park CH, Jin-Jeon M, et al. Feasibility of self-expandable metal stent for preservation of sphincter of Oddi function in patients with common bile duct stones: a pilot study. Gastrointest Endosc. 2015;pii:S0016-5107(15)00051-6.Google Scholar
  45. 45.
    Siddiqui AA, Mehendiratta V, Loren D, et al. Fully covered self-expandable metal stents are effective and safe to treat distal malignant biliary strictures, irrespective of surgical resectability status. J Clin Gastroenterol. 2011;45(9):824–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Kahaleh M, Brock A, Conaway MR, et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis. Endoscopy. 2007;39(4):319–24.CrossRefPubMedGoogle Scholar
  47. 47.
    Walter D, van Boeckel PG, Groenen MJ, et al. Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial. Gastroenterology. 2015;149(1):130–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Artinyan A, Anaya DA, McKenzie S, et al. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma. Cancer. 2011;117(10):2044–9):15.Google Scholar
  49. 49.
    Petrelli F, Coinu A, Borgonovo K, et al. FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: a meta-analytical review of published studies. Pancreas. 2015;44(4):515–21.CrossRefGoogle Scholar
  50. 50.
    Ge PS, Hamerski CM, Watson RR, et al. Plastic biliary stent patency in patients with locally advanced pancreatic adenocarcinoma receiving downstaging chemotherapy. Gastrointest Endosc. 2015;81:360–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Siddiqui AA, Mehendiratta V, Loren D, et al. Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients. Dig Dis Sci. 2013;58(6):1744–50.CrossRefPubMedGoogle Scholar
  52. 52.
    González-Huix F, Figa M, Alburquerque M, et al. Metallic vs. plastic stent in the preoperative treatment for biliary obstruction of resectable periampullary tumors: a randomized controlled trial [abstract]. Gastrointest Endosc. 2014;79:AB401.CrossRefGoogle Scholar
  53. 53.
    Tol JA, van Hooft JE, Timmer R, et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2015;pii:gutjnl-2014-308762.Google Scholar
  54. 54.
    Born P, Neuhaus H, Rosch T, et al. Initial experience with a new, partially covered Wallstent for malignant biliary obstruction. Endoscopy. 1996;28:699–702.CrossRefPubMedGoogle Scholar
  55. 55.
    Hausegger KA, Thurnher S, Bordendofer G, et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol. 1998;170:403–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Kullman E, Frozanpor F, Söderlund C, 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;72:915–23.CrossRefPubMedGoogle Scholar
  57. 57.
    Lee JH, Krishna SG, Singh A, et al. Comparison of the utility of covered metal stents versus uncovered metal stents in the management of malignant biliary strictures in 749 patients. Gastrointest Endosc. 2013;78(2):312–24.CrossRefPubMedGoogle Scholar
  58. 58.
    Telford JJ, Carr-Locke DL, Baron TH, et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 2010;72:907–14.CrossRefPubMedGoogle Scholar
  59. 59.
    Lee SJ, Kim MD, Lee MS, et al. Comparison of the efficacy of covered versus uncovered metallic stents in treating inoperable malignant common bile duct obstruction: a randomized trial. J Vasc Interv Radiol. 2014;25(12):1912–20.CrossRefPubMedGoogle Scholar
  60. 60.
    Ung KA, Stotzer PO, Nilsson A, et al. Covered and uncovered self-expandable metallic Hanarostents are equally efficacious in the drainage of extrahepatic malignant strictures. Results of a double-blind randomized study. Scand J Gastroenterol. 2013;48:459–65.CrossRefPubMedGoogle Scholar
  61. 61.
    Yang MJ, Kim JH, Yoo BM, 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.CrossRefPubMedGoogle Scholar
  62. 62.
    Gwon DI, Ko GY, Kim JH, et al. A comparative analysis of PTFE covered and uncovered stents for palliative treatment of malignant extrahepatic biliary obstruction. AJR Am J Roentgenol. 2010;195(6):W463–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Krokidis M, Fanelli F, Orgera G, et al. Percutaneous palliation of pancreatic head cancer: Randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents. Cardiovasc Intervent Radiol. 2011;34:352–61.CrossRefPubMedGoogle Scholar
  64. 64.
    Krokidis M, Fanelli F, Orgera G, et al. Percutaneous treatment of malignant jaundice due to extrahepatic cholangiocarcinoma: covered viabil stent versus uncovered wallstents. Cardiovasc Intervent Radiol. 2010;33:97–106.CrossRefPubMedGoogle Scholar
  65. 65.
    Kitano M, Yamashita Y, Tanaka K, et al. Drastic improvement of patency of covered self-expandable metal stents for distal biliary obstruction caused by pancreatic carcinomas: a randomized multicenter study comparing covered and uncovered stents. Gastrointest Endosc. 2013;108(11):1713–22.Google Scholar
  66. 66.
    Hu B, Wang TT, Wu J, et al. Antireflux stents to reduce the risk of cholangitis in patients with malignant biliary strictures: a randomized trial. Endoscopy. 2014;46(2):120–6.CrossRefPubMedGoogle Scholar
  67. 67.
    Nakai Y, Isayama H, Kawakubo K, et al. Metallic stent with high axial force as a risk factor for cholecystitis in distal malignant biliary obstruction. J Gastroenterol Hepatol. 2014;29(7):1557–62.CrossRefPubMedGoogle Scholar
  68. 68.
    Shimizu S, Naitoh I, Nakazawa T, et al. Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction. J Gastroenterol Hepatol. 2013;28(1):68–72.CrossRefPubMedGoogle Scholar
  69. 69.
    Kawakubo K, Isayama H, Nakai Y, et al. Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc. 2012;26(3):771–6.CrossRefPubMedGoogle Scholar
  70. 70.
    Hayashi T, Kawakami H, Osanai M, et al. No benefit of endoscopic sphincterotomy before biliary placement of self-expandable metal stents for unresectable pancreatic cancer. Clin Gastroenterol Hepatol. 2015;13:1151–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Wang AY, Ellen K, Berg CL, et al. Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data—a case series. Endoscopy. 2009;781–786(9):41.Google Scholar
  72. 72.
    Phillips MS, Bonatti H, Sauer BG, et al. Elevated stricture rate following the use of fully covered self-expandable metal biliary stents for biliary leaks following liver transplantation. Endoscopy. 2011;43:512–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Moon JH, Choi HJ, Koo HC, et al. Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent induced bile duct injury in patients with refractory benign biliary strictures. Gastrointest Endosc. 2012;75(5):1080–5.CrossRefPubMedGoogle Scholar
  74. 74.
    Mangiavillano B, Manes G, Baron TH, et al. The use of double lasso, fully covered self-expandable metal stents with new “anchoring flap” system in the treatment of benign biliary diseases. Dig Dis Sci. 2014;59:2308–13.CrossRefPubMedGoogle Scholar
  75. 75.
    Ryozawa S, Isayama H, Maetani I, et al. A prospective multicenter study of a fully-covered metal stent in patients with distal malignant biliary obstruction: WATCH-2 study. Gastrointest Endosc. 2013;77:AB309.CrossRefGoogle Scholar
  76. 76.
    Isayama H, Kawakubo K, Nakai Y, et al. A novel fully covered laser-cut nitinol stent with antimigration properties for non-resectable distal malignant biliary obstruction: a multicenter feasibility study. Gut Liver. 2013;7:725–30.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Park JK, Moon JH, Choi HJ, et al. Anchoring of a fully covered self-expandable metal stent with a 5F double pigtail plastic stent to prevent migration in the management of benign biliary strictures. Am J Gastroenterol. 2011;106(10):1761–5.CrossRefPubMedGoogle Scholar
  78. 78.
    Misra SP, Dwivedi M. Reflux of duodenal contents and cholangitis in patients undergoing self-expanding metal stent placement. Gastrointest Endosc. 2009;70(2):317–21.CrossRefPubMedGoogle Scholar
  79. 79.
    Okamoto T, Fujioka S, Yanagisawa S, et al. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis. Gastrointest Endosc. 2006;63(6):792–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Hu B, Wang TT, Shi ZM, et al. A novel antireflux metal stent for the palliation of biliary malignancies: a pilot feasibility study (with video). Gastrointest Endosc. 2011;73:143–8.CrossRefPubMedGoogle Scholar
  81. 81.
    Hamada T, Isayama H, Nakai Y, et al. Novel antireflux covered metal stent for recurrent occlusion of biliary metal stents: a pilot study. Dig Endosc. 2014;26(2):264–9.CrossRefPubMedGoogle Scholar
  82. 82.
    Lee DK, Kim HS, Kim KS, Lee WJ, Kim HK, Won YH, et al. The effect on porcine bile duct of a metallic stent covered with a paclitaxel-incorporated membrane. Gastrointest Endosc. 2005;61:296–301.CrossRefPubMedGoogle Scholar
  83. 83.
    Lee SS, Shin JH, Han JM, Cho CH, Kim MH, Lee SK, et al. Histologic influence of paclitaxel-eluting covered metallic stents in a canine biliary model. Gastrointest Endosc. 2009;69:1140–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Suk KT, Kim JW, Kim HS, Baik SK, Oh SJ, Lee SJ, et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc. 2007;66:798–803.CrossRefPubMedGoogle Scholar
  85. 85.
    Song TJ, Lee SS, Yun SC, Park do H, Seo DW, Lee SK, et al. Paclitaxel-eluting covered metal stents versus covered metal stents for distal malignant biliary obstruction: a prospective comparative pilot study. Gastrointest Endosc. 2011;73:727–33.CrossRefPubMedGoogle Scholar
  86. 86.
    Jang SI, Kim JH, Kim M, Yang S, Jo EA, Lee JW, et al. Porcine feasibility and safety study of a new paclitaxel-eluting biliary stent with a Pluronic-containing membrane. Endoscopy. 2012;44:825–31.CrossRefPubMedGoogle Scholar
  87. 87.
    Chung MJ, Kim H, Kim KS, Park S, Chung JB, Park SW. Safety evaluation of self-expanding metallic biliary stents eluting gemcitabine in a porcine model. J Gastroenterol Hepatol. 2012;27:261–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Ginsberg G, Cope C, Shah J, et al. In vivo evaluation of a new bioabsorbable self-expanding biliary stent. Gastrointest Endosc. 2003;58:777–84.CrossRefPubMedGoogle Scholar
  89. 89.
    Itoi T, Kasuya K, Abe Y, Isayama H. Endoscopic placement of a new short-term biodegradable pancreatic and biliary stent in an animal model: a preliminary feasibility study (with videos). J Hepatobiliary Pancreat Sci. 2011;18:463–7.CrossRefPubMedGoogle Scholar
  90. 90.
    Yamamoto K, Yoshioka T, Furuichi K, et al. Experimental study of poly-l-lactic acid biodegradable stents in normal canine bile ducts. Cardiovasc Intervent Radiol. 2011;34:601–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Nabi Zaheer
    • 1
    • 2
  • D. Nageshwar Reddy
    • 1
    • 2
  • Sundeep Lakhtakia
    • 1
    • 2
  1. 1.Department of Medical GastroenterologyAsian Institute of GastroenterologySomajiguda, HyderabadIndia
  2. 2.World Endoscopy OrganisationMunichGermany

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