Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options?
BACKGROUND:Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS. AIM:To prospectively evaluate the efficacy and sa...
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| Veröffentlicht in: | Journal of clinical gastroenterology 2013-09, Vol.47 (8), p.695-699 |
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| creator | Kahaleh, Michel Brijbassie, Alan Sethi, Amrita DeGaetani, Marisa Poneros, John M. Loren, David E. Kowalski, Thomas E. Sejpal, Divyesh V. Patel, Sandeep Rosenkranz, Laura McNamara, Kevin N. Raijman, Isaac Talreja, Jayant P. Gaidhane, Monica Sauer, Bryan G. Stevens, Peter D. |
| description | BACKGROUND:Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS.
AIM:To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS.
PATIENTS AND METHODS:Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications.
RESULTS:A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as followspostsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)].
CONCLUSIONS:FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time. |
| doi_str_mv | 10.1097/MCG.0b013e31827fd311 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1443384128</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1443384128</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2201-2292a5b7a7245e42bb4165fd767f6086d1af0ba2d6e31da4aeee833d1db098943</originalsourceid><addsrcrecordid>eNp9UctOGzEUtaqikqb9g6ryspsBX9uZBxvURikgEUWCsB55xneIW2dm6kegv8EXYxRgwYLVXdzzuPccQr4BOwJWFcfL-dkRaxgIFFDyotMC4AOZwExUGWcCPpIJg4pnrKjYIfns_R_GoBACPpFDLqTkpcgn5GEZbTAt9gEdXTujLF3slI0qmP6Whg3SG4906Oh82KFDTa_Rdhnej6rXT4glhkS5DknAU9PTX9ib2zSMNcr9Twtn2hAd-hO6NlukYaBXuDPeBLqKyXGDTo0Y0wl0NQYz9P70CznolPX49XlOyc3vxXp-nl2uzi7mPy-zlnMGGecVV7OmUAWXM5S8aSTks04XedHlrMw1qI41ius8BaSVVIhYCqFBN6wqKymm5Mded3TDv4g-1FvjW7RW9ThEX4OUQpQSUlBTIvfQ1g3eO-zq0ZlterAGVj-1Uac26rdtJNr3Z4fYbFG_kl7iT4ByD7gbbCrA_7XxDl29QWXD5n3tR4W_mjk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1443384128</pqid></control><display><type>article</type><title>Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options?</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Kahaleh, Michel ; Brijbassie, Alan ; Sethi, Amrita ; DeGaetani, Marisa ; Poneros, John M. ; Loren, David E. ; Kowalski, Thomas E. ; Sejpal, Divyesh V. ; Patel, Sandeep ; Rosenkranz, Laura ; McNamara, Kevin N. ; Raijman, Isaac ; Talreja, Jayant P. ; Gaidhane, Monica ; Sauer, Bryan G. ; Stevens, Peter D.</creator><creatorcontrib>Kahaleh, Michel ; Brijbassie, Alan ; Sethi, Amrita ; DeGaetani, Marisa ; Poneros, John M. ; Loren, David E. ; Kowalski, Thomas E. ; Sejpal, Divyesh V. ; Patel, Sandeep ; Rosenkranz, Laura ; McNamara, Kevin N. ; Raijman, Isaac ; Talreja, Jayant P. ; Gaidhane, Monica ; Sauer, Bryan G. ; Stevens, Peter D.</creatorcontrib><description>BACKGROUND:Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS.
AIM:To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS.
PATIENTS AND METHODS:Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications.
RESULTS:A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as followspostsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)].
CONCLUSIONS:FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.</description><identifier>ISSN: 0192-0790</identifier><identifier>EISSN: 1539-2031</identifier><identifier>DOI: 10.1097/MCG.0b013e31827fd311</identifier><identifier>PMID: 23442836</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Biliary Tract Diseases - pathology ; Biliary Tract Diseases - therapy ; Constriction, Pathologic - pathology ; Constriction, Pathologic - therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Stents - adverse effects ; Treatment Outcome</subject><ispartof>Journal of clinical gastroenterology, 2013-09, Vol.47 (8), p.695-699</ispartof><rights>2013 by Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2201-2292a5b7a7245e42bb4165fd767f6086d1af0ba2d6e31da4aeee833d1db098943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23442836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kahaleh, Michel</creatorcontrib><creatorcontrib>Brijbassie, Alan</creatorcontrib><creatorcontrib>Sethi, Amrita</creatorcontrib><creatorcontrib>DeGaetani, Marisa</creatorcontrib><creatorcontrib>Poneros, John M.</creatorcontrib><creatorcontrib>Loren, David E.</creatorcontrib><creatorcontrib>Kowalski, Thomas E.</creatorcontrib><creatorcontrib>Sejpal, Divyesh V.</creatorcontrib><creatorcontrib>Patel, Sandeep</creatorcontrib><creatorcontrib>Rosenkranz, Laura</creatorcontrib><creatorcontrib>McNamara, Kevin N.</creatorcontrib><creatorcontrib>Raijman, Isaac</creatorcontrib><creatorcontrib>Talreja, Jayant P.</creatorcontrib><creatorcontrib>Gaidhane, Monica</creatorcontrib><creatorcontrib>Sauer, Bryan G.</creatorcontrib><creatorcontrib>Stevens, Peter D.</creatorcontrib><title>Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options?</title><title>Journal of clinical gastroenterology</title><addtitle>J Clin Gastroenterol</addtitle><description>BACKGROUND:Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS.
AIM:To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS.
PATIENTS AND METHODS:Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications.
RESULTS:A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as followspostsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)].
CONCLUSIONS:FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.</description><subject>Adult</subject><subject>Aged</subject><subject>Biliary Tract Diseases - pathology</subject><subject>Biliary Tract Diseases - therapy</subject><subject>Constriction, Pathologic - pathology</subject><subject>Constriction, Pathologic - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Stents - adverse effects</subject><subject>Treatment Outcome</subject><issn>0192-0790</issn><issn>1539-2031</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UctOGzEUtaqikqb9g6ryspsBX9uZBxvURikgEUWCsB55xneIW2dm6kegv8EXYxRgwYLVXdzzuPccQr4BOwJWFcfL-dkRaxgIFFDyotMC4AOZwExUGWcCPpIJg4pnrKjYIfns_R_GoBACPpFDLqTkpcgn5GEZbTAt9gEdXTujLF3slI0qmP6Whg3SG4906Oh82KFDTa_Rdhnej6rXT4glhkS5DknAU9PTX9ib2zSMNcr9Twtn2hAd-hO6NlukYaBXuDPeBLqKyXGDTo0Y0wl0NQYz9P70CznolPX49XlOyc3vxXp-nl2uzi7mPy-zlnMGGecVV7OmUAWXM5S8aSTks04XedHlrMw1qI41ius8BaSVVIhYCqFBN6wqKymm5Mded3TDv4g-1FvjW7RW9ThEX4OUQpQSUlBTIvfQ1g3eO-zq0ZlterAGVj-1Uac26rdtJNr3Z4fYbFG_kl7iT4ByD7gbbCrA_7XxDl29QWXD5n3tR4W_mjk</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Kahaleh, Michel</creator><creator>Brijbassie, Alan</creator><creator>Sethi, Amrita</creator><creator>DeGaetani, Marisa</creator><creator>Poneros, John M.</creator><creator>Loren, David E.</creator><creator>Kowalski, Thomas E.</creator><creator>Sejpal, Divyesh V.</creator><creator>Patel, Sandeep</creator><creator>Rosenkranz, Laura</creator><creator>McNamara, Kevin N.</creator><creator>Raijman, Isaac</creator><creator>Talreja, Jayant P.</creator><creator>Gaidhane, Monica</creator><creator>Sauer, Bryan G.</creator><creator>Stevens, Peter D.</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201309</creationdate><title>Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options?</title><author>Kahaleh, Michel ; Brijbassie, Alan ; Sethi, Amrita ; DeGaetani, Marisa ; Poneros, John M. ; Loren, David E. ; Kowalski, Thomas E. ; Sejpal, Divyesh V. ; Patel, Sandeep ; Rosenkranz, Laura ; McNamara, Kevin N. ; Raijman, Isaac ; Talreja, Jayant P. ; Gaidhane, Monica ; Sauer, Bryan G. ; Stevens, Peter D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2201-2292a5b7a7245e42bb4165fd767f6086d1af0ba2d6e31da4aeee833d1db098943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biliary Tract Diseases - pathology</topic><topic>Biliary Tract Diseases - therapy</topic><topic>Constriction, Pathologic - pathology</topic><topic>Constriction, Pathologic - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Stents - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kahaleh, Michel</creatorcontrib><creatorcontrib>Brijbassie, Alan</creatorcontrib><creatorcontrib>Sethi, Amrita</creatorcontrib><creatorcontrib>DeGaetani, Marisa</creatorcontrib><creatorcontrib>Poneros, John M.</creatorcontrib><creatorcontrib>Loren, David E.</creatorcontrib><creatorcontrib>Kowalski, Thomas E.</creatorcontrib><creatorcontrib>Sejpal, Divyesh V.</creatorcontrib><creatorcontrib>Patel, Sandeep</creatorcontrib><creatorcontrib>Rosenkranz, Laura</creatorcontrib><creatorcontrib>McNamara, Kevin N.</creatorcontrib><creatorcontrib>Raijman, Isaac</creatorcontrib><creatorcontrib>Talreja, Jayant P.</creatorcontrib><creatorcontrib>Gaidhane, Monica</creatorcontrib><creatorcontrib>Sauer, Bryan G.</creatorcontrib><creatorcontrib>Stevens, Peter D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kahaleh, Michel</au><au>Brijbassie, Alan</au><au>Sethi, Amrita</au><au>DeGaetani, Marisa</au><au>Poneros, John M.</au><au>Loren, David E.</au><au>Kowalski, Thomas E.</au><au>Sejpal, Divyesh V.</au><au>Patel, Sandeep</au><au>Rosenkranz, Laura</au><au>McNamara, Kevin N.</au><au>Raijman, Isaac</au><au>Talreja, Jayant P.</au><au>Gaidhane, Monica</au><au>Sauer, Bryan G.</au><au>Stevens, Peter D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options?</atitle><jtitle>Journal of clinical gastroenterology</jtitle><addtitle>J Clin Gastroenterol</addtitle><date>2013-09</date><risdate>2013</risdate><volume>47</volume><issue>8</issue><spage>695</spage><epage>699</epage><pages>695-699</pages><issn>0192-0790</issn><eissn>1539-2031</eissn><abstract>BACKGROUND:Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS.
AIM:To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS.
PATIENTS AND METHODS:Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications.
RESULTS:A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as followspostsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)].
CONCLUSIONS:FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>23442836</pmid><doi>10.1097/MCG.0b013e31827fd311</doi><tpages>5</tpages></addata></record> |
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| ispartof | Journal of clinical gastroenterology, 2013-09, Vol.47 (8), p.695-699 |
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| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Biliary Tract Diseases - pathology Biliary Tract Diseases - therapy Constriction, Pathologic - pathology Constriction, Pathologic - therapy Female Humans Logistic Models Male Middle Aged Prospective Studies Retrospective Studies Stents - adverse effects Treatment Outcome |
| title | Multicenter Trial Evaluating the Use of Covered Self-expanding Metal Stents in Benign Biliary Strictures: Time to Revisit Our Therapeutic Options? |
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