Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction

Background and Aim Endoscopic biliary and duodenal stenting (DS; double stenting) is widely accepted as a palliation therapy for malignant bilioduodenal obstruction. The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS. Met...

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Veröffentlicht in:Journal of gastroenterology and hepatology 2018-03, Vol.33 (3), p.696-703
Hauptverfasser: Hori, Yasuki, Naitoh, Itaru, Hayashi, Kazuki, Kondo, Hiromu, Yoshida, Michihiro, Shimizu, Shuya, Hirano, Atsuyuki, Okumura, Fumihiro, Ando, Tomoaki, Jinno, Naruomi, Takada, Hiroki, Togawa, Shozo, Joh, Takashi
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container_issue 3
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container_title Journal of gastroenterology and hepatology
container_volume 33
creator Hori, Yasuki
Naitoh, Itaru
Hayashi, Kazuki
Kondo, Hiromu
Yoshida, Michihiro
Shimizu, Shuya
Hirano, Atsuyuki
Okumura, Fumihiro
Ando, Tomoaki
Jinno, Naruomi
Takada, Hiroki
Togawa, Shozo
Joh, Takashi
description Background and Aim Endoscopic biliary and duodenal stenting (DS; double stenting) is widely accepted as a palliation therapy for malignant bilioduodenal obstruction. The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS. Methods Patients who underwent DS from April 2004 to March 2017 were analyzed retrospectively with regard to clinical outcomes and predictive factors of recurrent biliary and duodenal obstruction (recurrent biliary obstruction [RBO] and recurrent duodenal obstruction [RDO]). Results A total of 109 consecutive patients was enrolled. Technical success of DS was achieved in 108 patients (99.1%). Symptoms due to biliary and duodenal obstruction were improved in 89 patients (81.7%). RBO occurred in 25 patients (22.9%) and RDO in 13 (11.9%). The median times to RBO and RDO from DS were 87 and 76 days, respectively. Placement of a duodenal uncovered self‐expandable metal stent (U‐SEMS) was significantly associated with RBO in the multivariable analysis (P = 0.007). Time to RBO was significantly longer in the duodenal covered self‐expandable metal stent group than in the U‐SEMS group (P = 0.003). No predictive factors of RDO were detected, and duodenal stent type was not associated with the time to RDO (P = 0.724). Conclusions Double stenting was safe and effective for malignant bilioduodenal obstruction. Duodenal U‐SEMS is a risk factor for RBO. The covered self‐expandable metal stent is the preferred type of duodenal SEMS in patients with DS (Clinical trial registration number: UMIN000027606).
doi_str_mv 10.1111/jgh.13977
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The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS. Methods Patients who underwent DS from April 2004 to March 2017 were analyzed retrospectively with regard to clinical outcomes and predictive factors of recurrent biliary and duodenal obstruction (recurrent biliary obstruction [RBO] and recurrent duodenal obstruction [RDO]). Results A total of 109 consecutive patients was enrolled. Technical success of DS was achieved in 108 patients (99.1%). Symptoms due to biliary and duodenal obstruction were improved in 89 patients (81.7%). RBO occurred in 25 patients (22.9%) and RDO in 13 (11.9%). The median times to RBO and RDO from DS were 87 and 76 days, respectively. Placement of a duodenal uncovered self‐expandable metal stent (U‐SEMS) was significantly associated with RBO in the multivariable analysis (P = 0.007). Time to RBO was significantly longer in the duodenal covered self‐expandable metal stent group than in the U‐SEMS group (P = 0.003). No predictive factors of RDO were detected, and duodenal stent type was not associated with the time to RDO (P = 0.724). Conclusions Double stenting was safe and effective for malignant bilioduodenal obstruction. Duodenal U‐SEMS is a risk factor for RBO. The covered self‐expandable metal stent is the preferred type of duodenal SEMS in patients with DS (Clinical trial registration number: UMIN000027606).</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.13977</identifier><identifier>PMID: 28902972</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; bilioduodenal obstruction ; Cholestasis - surgery ; double stenting ; Duodenal Obstruction - surgery ; Endoscopy, Digestive System - methods ; Female ; Forecasting ; Humans ; Implants ; Male ; Middle Aged ; Palliation ; Recurrence ; Retrospective Studies ; Risk Factors ; Self Expandable Metallic Stents - adverse effects ; self‐expandable metal stent ; Stents ; Treatment Outcome</subject><ispartof>Journal of gastroenterology and hepatology, 2018-03, Vol.33 (3), p.696-703</ispartof><rights>2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley &amp; Sons Australia, Ltd</rights><rights>2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley &amp; Sons Australia, Ltd.</rights><rights>2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley &amp; Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4197-98536330bf725d109a2999d984c9ace81729ba634256015050c66f65559ce38e3</citedby><cites>FETCH-LOGICAL-c4197-98536330bf725d109a2999d984c9ace81729ba634256015050c66f65559ce38e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.13977$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.13977$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28902972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hori, Yasuki</creatorcontrib><creatorcontrib>Naitoh, Itaru</creatorcontrib><creatorcontrib>Hayashi, Kazuki</creatorcontrib><creatorcontrib>Kondo, Hiromu</creatorcontrib><creatorcontrib>Yoshida, Michihiro</creatorcontrib><creatorcontrib>Shimizu, Shuya</creatorcontrib><creatorcontrib>Hirano, Atsuyuki</creatorcontrib><creatorcontrib>Okumura, Fumihiro</creatorcontrib><creatorcontrib>Ando, Tomoaki</creatorcontrib><creatorcontrib>Jinno, Naruomi</creatorcontrib><creatorcontrib>Takada, Hiroki</creatorcontrib><creatorcontrib>Togawa, Shozo</creatorcontrib><creatorcontrib>Joh, Takashi</creatorcontrib><title>Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim Endoscopic biliary and duodenal stenting (DS; double stenting) is widely accepted as a palliation therapy for malignant bilioduodenal obstruction. The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS. Methods Patients who underwent DS from April 2004 to March 2017 were analyzed retrospectively with regard to clinical outcomes and predictive factors of recurrent biliary and duodenal obstruction (recurrent biliary obstruction [RBO] and recurrent duodenal obstruction [RDO]). Results A total of 109 consecutive patients was enrolled. Technical success of DS was achieved in 108 patients (99.1%). Symptoms due to biliary and duodenal obstruction were improved in 89 patients (81.7%). RBO occurred in 25 patients (22.9%) and RDO in 13 (11.9%). The median times to RBO and RDO from DS were 87 and 76 days, respectively. Placement of a duodenal uncovered self‐expandable metal stent (U‐SEMS) was significantly associated with RBO in the multivariable analysis (P = 0.007). Time to RBO was significantly longer in the duodenal covered self‐expandable metal stent group than in the U‐SEMS group (P = 0.003). No predictive factors of RDO were detected, and duodenal stent type was not associated with the time to RDO (P = 0.724). Conclusions Double stenting was safe and effective for malignant bilioduodenal obstruction. Duodenal U‐SEMS is a risk factor for RBO. The covered self‐expandable metal stent is the preferred type of duodenal SEMS in patients with DS (Clinical trial registration number: UMIN000027606).</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>bilioduodenal obstruction</subject><subject>Cholestasis - surgery</subject><subject>double stenting</subject><subject>Duodenal Obstruction - surgery</subject><subject>Endoscopy, Digestive System - methods</subject><subject>Female</subject><subject>Forecasting</subject><subject>Humans</subject><subject>Implants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Palliation</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Self Expandable Metallic Stents - adverse effects</subject><subject>self‐expandable metal stent</subject><subject>Stents</subject><subject>Treatment Outcome</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EokvhwAsgS1zgkHbs2HHMDa1KW1SJSzlbjjPZZuWNFzuh3RuPUF6RJ8G7aXtAYi4j_frmn7F_Qt4yOGG5TtermxNWaqWekQUTAgqmRPWcLKBmstAl00fkVUprABCg5EtyxGsNXCu-IL-X4SdGbGk7hRYH62lC3_35dY93Wzu0tvFINzju9RGHMdFtDD4MK9r0vrdxN8t0a3NzO9oPtA3Tfuig98PqE72-QeptXGEas3nsMdHQHebD09LQpDFObuzD8Jq86KxP-OahH5PvX86ulxfF1bfzy-Xnq8IJplWha1lWZQlNp7hsGWjLtdatroXT1mHNFNeNrUrBZQVMggRXVV0lpdQOyxrLY_Jh9s0v-jHl48ymTw69twOGKRmmy7quQDLI6Pt_0HWYYr47GQ6gQCjORKY-zpSLIaWIndnGfpP_yDAw-5xMzskccsrsuwfHqdlg-0Q-BpOB0xm47T3u_u9kvp5fzJZ_ASACnqE</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Hori, Yasuki</creator><creator>Naitoh, Itaru</creator><creator>Hayashi, Kazuki</creator><creator>Kondo, Hiromu</creator><creator>Yoshida, Michihiro</creator><creator>Shimizu, Shuya</creator><creator>Hirano, Atsuyuki</creator><creator>Okumura, Fumihiro</creator><creator>Ando, Tomoaki</creator><creator>Jinno, Naruomi</creator><creator>Takada, Hiroki</creator><creator>Togawa, Shozo</creator><creator>Joh, Takashi</creator><general>Wiley Subscription Services, Inc</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>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction</title><author>Hori, Yasuki ; Naitoh, Itaru ; Hayashi, Kazuki ; Kondo, Hiromu ; Yoshida, Michihiro ; Shimizu, Shuya ; Hirano, Atsuyuki ; Okumura, Fumihiro ; Ando, Tomoaki ; Jinno, Naruomi ; Takada, Hiroki ; Togawa, Shozo ; Joh, Takashi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4197-98536330bf725d109a2999d984c9ace81729ba634256015050c66f65559ce38e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>bilioduodenal obstruction</topic><topic>Cholestasis - surgery</topic><topic>double stenting</topic><topic>Duodenal Obstruction - surgery</topic><topic>Endoscopy, Digestive System - methods</topic><topic>Female</topic><topic>Forecasting</topic><topic>Humans</topic><topic>Implants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Palliation</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Self Expandable Metallic Stents - adverse effects</topic><topic>self‐expandable metal stent</topic><topic>Stents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hori, Yasuki</creatorcontrib><creatorcontrib>Naitoh, Itaru</creatorcontrib><creatorcontrib>Hayashi, Kazuki</creatorcontrib><creatorcontrib>Kondo, Hiromu</creatorcontrib><creatorcontrib>Yoshida, Michihiro</creatorcontrib><creatorcontrib>Shimizu, Shuya</creatorcontrib><creatorcontrib>Hirano, Atsuyuki</creatorcontrib><creatorcontrib>Okumura, Fumihiro</creatorcontrib><creatorcontrib>Ando, Tomoaki</creatorcontrib><creatorcontrib>Jinno, Naruomi</creatorcontrib><creatorcontrib>Takada, Hiroki</creatorcontrib><creatorcontrib>Togawa, Shozo</creatorcontrib><creatorcontrib>Joh, Takashi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hori, Yasuki</au><au>Naitoh, Itaru</au><au>Hayashi, Kazuki</au><au>Kondo, Hiromu</au><au>Yoshida, Michihiro</au><au>Shimizu, Shuya</au><au>Hirano, Atsuyuki</au><au>Okumura, Fumihiro</au><au>Ando, Tomoaki</au><au>Jinno, Naruomi</au><au>Takada, Hiroki</au><au>Togawa, Shozo</au><au>Joh, Takashi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2018-03</date><risdate>2018</risdate><volume>33</volume><issue>3</issue><spage>696</spage><epage>703</epage><pages>696-703</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background and Aim Endoscopic biliary and duodenal stenting (DS; double stenting) is widely accepted as a palliation therapy for malignant bilioduodenal obstruction. The aim of the current study was to investigate the patency and adverse events of duodenal and biliary stents in patients with DS. Methods Patients who underwent DS from April 2004 to March 2017 were analyzed retrospectively with regard to clinical outcomes and predictive factors of recurrent biliary and duodenal obstruction (recurrent biliary obstruction [RBO] and recurrent duodenal obstruction [RDO]). Results A total of 109 consecutive patients was enrolled. Technical success of DS was achieved in 108 patients (99.1%). Symptoms due to biliary and duodenal obstruction were improved in 89 patients (81.7%). RBO occurred in 25 patients (22.9%) and RDO in 13 (11.9%). The median times to RBO and RDO from DS were 87 and 76 days, respectively. Placement of a duodenal uncovered self‐expandable metal stent (U‐SEMS) was significantly associated with RBO in the multivariable analysis (P = 0.007). Time to RBO was significantly longer in the duodenal covered self‐expandable metal stent group than in the U‐SEMS group (P = 0.003). No predictive factors of RDO were detected, and duodenal stent type was not associated with the time to RDO (P = 0.724). Conclusions Double stenting was safe and effective for malignant bilioduodenal obstruction. Duodenal U‐SEMS is a risk factor for RBO. The covered self‐expandable metal stent is the preferred type of duodenal SEMS in patients with DS (Clinical trial registration number: UMIN000027606).</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28902972</pmid><doi>10.1111/jgh.13977</doi><tpages>8</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
bilioduodenal obstruction
Cholestasis - surgery
double stenting
Duodenal Obstruction - surgery
Endoscopy, Digestive System - methods
Female
Forecasting
Humans
Implants
Male
Middle Aged
Palliation
Recurrence
Retrospective Studies
Risk Factors
Self Expandable Metallic Stents - adverse effects
self‐expandable metal stent
Stents
Treatment Outcome
title Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction
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