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Covered stents prove more effective in some distal biliary obstruction cases
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Use of covered, self-expanding metal stents that employ an anti-migration system resulted in improved patency duration without additional complications for patients with distal biliary obstruction caused by pancreatic carcinoma in a recent study.
“The rate of tumor ingrowth was significantly lower in the group of patients with covered SEMS [self-expanding metal stents],” the researchers wrote.
The prospective study analyzed 120 patients admitted to 22 tertiary-care centers because of distal biliary obstruction from unresectable pancreatic carcinomas. Patients were randomly assigned to receive covered (n=60) or uncovered (n=60) SEMS during endoscopic retrograde cholangiopancreatography at the stricture site.
While median patient survival time was not significantly greater (285 days in patients with covered stents vs. 223 days with uncovered stents), median survival time without stent dysfunction was greater for the covered stents (187 days vs. 132 days; P=.043). Covered SEMS also demonstrated longer mean patency (219.3 days ± 159.1 vs. 166.9 days ± 124.9; P=.047).
No stent dysfunction due to tumor ingrowth was found among patients with covered SEMS, while 25% of patients with uncovered SEMS experienced such dysfunction (P<.01).
Differences in stent dysfunction due to tumor overgrowth and sludge formation between covered and uncovered stents were not statistically significant.
Acute pancreatitis occurred in one patient who received a covered SEMS, while incidence of serious adverse events between groups was not significant.
“Covered SEMS with an anti-migration system had a longer duration of stent patency than uncovered SEMS,” the researchers concluded. “We therefore strongly recommend the use of these covered SEMS for the palliative treatment of patients with distal biliary obstruction due to unresectable pancreatic carcinoma.”
Disclosure: The researchers report no relevant financial disclosures.
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