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World J Gastroenterol. Jan 7, 2011; 17(1): 98-104
Published online Jan 7, 2011. doi: 10.3748/wjg.v17.i1.98
Endoscopic management of occluded biliary uncovered metal stents: A multicenter experience
Panagiotis Katsinelos, Athanasios Beltsis, Grigoris Chatzimavroudis, Dimitris Paikos, George Paroutoglou, Dimitris Kapetanos, Sotiris Terzoudis, Georgia Lazaraki, Ioannis Pilpilidis, Kostas Fasoulas, Stefanos Atmatzidis, Christos Zavos, Jannis Kountouras
Panagiotis Katsinelos, Athanasios Beltsis, Grigoris Chatzimavroudis, Sotiris Terzoudis, Kostas Fasoulas, Stefanos Atmatzidis, Department of Endoscopy and Motility Unit, “G. Gennimatas” General Hospital, 55132, Thessaloniki, Greece
Dimitris Paikos, Georgia Lazaraki, Ioannis Pilpilidis, Department of Gastroenterology, Theagenion Anticancer Hospital, 54642, Thessaloniki, Greece
George Paroutoglou, Department of Gastroenterology, University Hospital of Thessaly, 41222, Larissa, Greece
Dimitris Kapetanos, Department of Gastroenterology, “G. Papanikolaou” General Hospital, 55236, Thessaloniki, Greece
Christos Zavos, Jannis Kountouras, 2nd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, 54642, Thessaloniki, Greece
Author contributions: Katsinelos P, Paikos D, Paroutoglou G, Kapetanos D, Lazaraki G and Pilpilidis I performed the endocopies; Beltsis A, Chatzimavroudis G, Terzoudis S, Fasoulas K and Atmatzidis S analyzed and interpreted the patient data and reviewed the relative literature; Chatzimavroudis G performed the statistical analysis of data; Katsinelos P designed the study and wrote the manuscript; Zavos C and Kountouras J were major contributors in revising the manuscript critically for important intellectual content.
Correspondence to: Dr. Panagiotis Katsinelos, Assistant Professor, Head, Department of Endoscopy and Motility Unit, “G. Gennimatas” General Hospital, 55132, Thessaloniki, Greece. gchatzim@med.auth.gr
Telephone: +30-2310-211221 Fax: +30-2310-210401
Received: May 6, 2010
Revised: July 13, 2010
Accepted: July 20, 2010
Published online: January 7, 2011
AIM: To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents (SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.
METHODS: A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs. The technical success of performed treatment in occluded SEMSs, the patency of the stent, the need for re-intervention and the financial costs of each treatment were analyzed.
RESULTS: Fifty four patients were included in the analysis; 21 received Hanaro, 19 Wallstent and 14 Flexus. For the relief of obstruction, a plastic stent was inserted in 24 patients, a second SEMS in 25 and mechanical cleaning was performed in 5 patients. The overall median second patency rates between second SEMSs and plastic stents did not differ (133 d for SEMSs vs 106 d for plastic stents; P = 0.856). Similarly, no difference was found between the overall survival of SEMS and plastic stent groups, and no procedure-related complications occurred. Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.
CONCLUSION: Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs; insertion of plastic stents appears to be the most cost-effective strategy.
