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Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction.
MedLine Citation:
PMID:  23354625     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Endoscopic placement of covered self-expandable metallic stents (CSEMSs) is effective for distal malignant biliary obstruction. However, management of dysfunctional CSEMSs has not been established. METHODS: Between March 1998 and July 2007, a total of 74 patients who underwent endoscopic re-interventions for CSEMS dysfunction were analyzed. Second stent insertion (CSEMS or plastic stent) or mechanical cleaning of the occluded CSEMS was performed endoscopically. The period between second stent insertion and stent dysfunction or patient death (time to dysfunction; TTD) was calculated. The cleaned initial CSEMSs were analyzed as second stents. RESULTS: Dysfunction of the second stent occurred in 17 of 37 patients (45.9 %) in the CSEMS group, 16 of 20 (80.0 %) in the plastic stent group, and 13 of 17 (76.5 %) in the cleaning group. The median TTD of each group was 176, 57, and 46 days, respectively. The cumulative TTD was significantly higher in the CSEMS group than in the plastic stent and cleaning groups (P = 0.08). From the multivariate analysis, sludge occlusion of the first CSEMS was identified as a significant risk factor for second stent dysfunction (HR, 2.51; 95 % CI, 1.19-5.46), and placement of the second CSEMS significantly reduced the risk of dysfunction (HR, 0.39; 95 % CI, 0.18-0.79). CONCLUSIONS: Insertion of a new CSEMS should be considered as the treatment of choice for the management of dysfunctional CSEMSs.
Authors:
Osamu Togawa; Hiroyuki Isayama; Takeshi Tsujino; Yousuke Nakai; Hirofumi Kogure; Tsuyoshi Hamada; Takashi Sasaki; Yoko Yashima; Hiroshi Yagioka; Toshihiko Arizumi; Yukiko Ito; Saburo Matsubara; Natsuyo Yamamoto; Naoki Sasahira; Kenji Hirano; Nobuo Toda; Minoru Tada; Kazuhiko Koike
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-25
Journal Detail:
Title:  Journal of gastroenterology     Volume:  -     ISSN:  1435-5922     ISO Abbreviation:  J. Gastroenterol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9430794     Medline TA:  J Gastroenterol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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