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Uncovered Metallic Stenting

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Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases

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Abstract

Uncovered metallic stenting is typically used for unresectable distal or hilar malignant biliary obstruction. This chapter describes the approach, mechanical properties, and stenting techniques, as well as the outcome of uncovered metallic stenting in “distal” malignant biliary obstruction. Endoscopic biliary metal stenting is recommended for unresectable distal malignant biliary obstruction when patient life expectancy is longer than 4 months because the outcomes with metal stenting are superior to both surgical drainage and plastic stenting. The self-expandable metal stent is a metallic stent with a small predeployment diameter constrained by a sheath and a large post-deployment diameter when expanded. The mechanical properties of the metal stent are imparted by the stent material, stent mesh design, radial force, axial flexibility, foreshortening, radiopacity, covering membrane, and the anchoring mechanism. The adequate stent length can be measured using a graduated guidewire or the catheter distance measured outside the endoscope. During metal stent deployment, the position of the stent can be adjusted by applying additional traction or recapturing the metal stent. Reintervention for an occluded or migrated stent is also discussed at the end of this chapter.

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References

  1. Cipolletta L, Rotondano G, Marmo R, et al. Endoscopic palliation of malignant obstructive jaundice: an evidence-based review. Dig Liver Dis. 2007;39:375–88.

    Article  CAS  PubMed  Google Scholar 

  2. Stern N, Sturgess R. Endoscopic therapy in the management of malignant biliary obstruction. Eur J Surg Oncol. 2008;34:313–7.

    Article  CAS  PubMed  Google Scholar 

  3. Irisawa A, Katanuma A, Itoi T. Otaru consensus on biliary stenting for unresectable distal malignant biliary obstruction. Dig Endosc. 2013;25(Suppl 2):52–7.

    Article  PubMed  Google Scholar 

  4. Wassef W, Syed I. Designer stents: are we there yet? Gastrointest Endosc. 2007;66:804–8.

    Article  PubMed  Google Scholar 

  5. Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet. 1994;344:1655–60.

    Article  CAS  PubMed  Google Scholar 

  6. Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30:1132–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Moss AC, Morris E, Leyden J, et al. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev. 2007;33:213–21.

    Article  PubMed  Google Scholar 

  8. Jaganmohan S, Lee JH. Self-expandable metal stents in malignant biliary obstruction. Expert Rev Gastroenterol Hepatol. 2012;6:105–14.

    Article  CAS  PubMed  Google Scholar 

  9. Lee JH. Self-expandable metal stents for malignant distal biliary strictures. Gastrointest Endosc Clin N Am. 2011;21:463–80. viii–ix

    Article  PubMed  Google Scholar 

  10. Artifon EL, Sakai P, Cunha JE, et al. Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol. 2006;101:2031–7.

    Article  PubMed  Google Scholar 

  11. Park do H, Jang JW, Lee SS, et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc. 2011;74:1276–84.

    Article  PubMed  Google Scholar 

  12. Raijman I. Biliary and pancreatic stents. Gastrointest Endosc Clin N Am. 2003;13:561–92. vii–viii

    Article  PubMed  Google Scholar 

  13. Moparty B, Carr-Locke DL. Metal or plastic stent for malignant biliary obstruction: what's got the most bang for your buck? Eur J Gastroenterol Hepatol. 2007;19:1041–2.

    Article  PubMed  Google Scholar 

  14. Isayama H, Nakai Y, Kogure H, et al. Biliary self-expandable metallic stent for unresectable malignant distal biliary obstruction: which is better: covered or uncovered? Dig Endosc. 2013;25(Suppl 2):71–4.

    Article  PubMed  Google Scholar 

  15. Dumonceau JM, Heresbach D, Deviere J, et al. Biliary stents: models and methods for endoscopic stenting. Endoscopy. 2011;43:617–26.

    Article  PubMed  Google Scholar 

  16. Pfau PR, Pleskow DK, Banerjee S, et al. Pancreatic and biliary stents. Gastrointest Endosc. 2013;77:319–27.

    Article  PubMed  Google Scholar 

  17. Nelson D. Expandable metal stents: physical properties and tissue responses. Tech Gastrointest Endosc. 2001;3:70–4.

    Article  Google Scholar 

  18. 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;63:792–6.

    Article  PubMed  Google Scholar 

  19. Loew BJ, Howell DA, Sanders MK, et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc. 2009;70:445–53.

    Article  PubMed  Google Scholar 

  20. Dumonceau JM, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44:277–98.

    Article  PubMed  Google Scholar 

  21. Okano N, Igarashi Y, Kishimoto Y, et al. Necessity for endoscopic sphincterotomy for biliary stenting in cases of malignant biliary obstruction. Dig Endosc. 2013;25(Suppl 2):122–5.

    Article  PubMed  Google Scholar 

  22. 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;57:178–82.

    Article  PubMed  Google Scholar 

  23. 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;47:1–7.

    Article  CAS  PubMed  Google Scholar 

  24. Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–9.

    PubMed  CAS  Google Scholar 

  25. Yeoh KG, Zimmerman MJ, Cunningham JT, et al. Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc. 1999;49:466–71.

    Article  CAS  PubMed  Google Scholar 

  26. 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;82:256–67. e257

    Article  PubMed  Google Scholar 

  27. Baron TH. Best endoscopic stents for the biliary tree and pancreas. Curr Opin Gastroenterol. 2014;30:453–6.

    Article  PubMed  Google Scholar 

  28. Almadi MA, Barkun AN, Martel M. No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11:27–37. e21

    Article  PubMed  Google Scholar 

  29. Ito K, Ogawa T, Horaguchi J, et al. Reintervention for occluded biliary metal stent for patients with malignant distal biliary stricture. Dig Endosc. 2013;25(Suppl 2):126–31.

    Article  PubMed  Google Scholar 

  30. Ishii K, Itoi T, Sofuni A, et al. Endoscopic removal and trimming of distal self-expandable metallic biliary stents. World J Gastroenterol. 2011;17:2652–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yang Z, Wu Q, Wang F, et al. A systematic review and meta-analysis of randomized trials and prospective studies comparing covered and bare self-expandable metal stents for the treatment of malignant obstruction in the digestive tract. Int J Med Sci. 2013;10:825–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Shin HP, Kim MH, Jung SW, et al. Endoscopic removal of biliary self-expandable metallic stents: a prospective study. Endoscopy. 2006;38:1250–5.

    Article  CAS  PubMed  Google Scholar 

  33. Cho JH, Jeon TJ, Park JY, et al. Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction. Surg Endosc. 2011;25:475–82.

    Article  PubMed  Google Scholar 

  34. Tan DM, Lillemoe KD, Fogel EL. A new technique for endoscopic removal of uncovered biliary self-expandable metal stents: stent-in-stent technique with a fully covered biliary stent. Gastrointest Endosc. 2012;75:923–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do, 481-070, South Korea

    Sung-Hoon Moon M.D., Ph.D.

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  1. Sung-Hoon Moon M.D., Ph.D.
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Correspondence to Sung-Hoon Moon M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Internal Medicine, School of Medicine, University of Tokai, Isehara, Kanagawa, Japan

    Tetsuya Mine

  2. Sankikai Medical Corporation, Yokohama, Kanagawa, Japan

    Rikiya Fujita

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Moon, SH. (2019). Uncovered Metallic Stenting. In: Mine, T., Fujita, R. (eds) Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56009-8_27

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  • DOI: https://doi.org/10.1007/978-4-431-56009-8_27

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-56007-4

  • Online ISBN: 978-4-431-56009-8

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