Published online May 21, 2019. doi: 10.3748/wjg.v25.i19.2373
Peer-review started: March 14, 2019
First decision: March 27, 2019
Revised: March 28, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 21, 2019
Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relatively short duration of stent patency. Although self-expanding metal stents (SEMSs) have a longer patency period than plastic stents (PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS (ARPS) has been proposed. We developed a new ARPS with a “duckbilled” valve attached to the duodenal end of the stent.
To compare the patency of ARPSs with that of traditional PSs (TPSs) in patients with unresectable distal MBO.
We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success, adverse events, and patient survival.
Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events (P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range (IQR), 170], which was significantly longer than that in the TPS group (median, 130 d; IQR, 90, P = 0.005). No significant difference in patient survival was noted between the two groups (P = 0.900).
The new ARPS is safe and effective for the palliation of unresectable distal MBO, and has a significantly longer stent patency than a TPS.
Core tip: There is no ideal design for an antireflux plastic stent for prolonging stent patency. In this study, a newly designed antireflux plastic stent with a “duckbilled” valve was successfully deployed in patients with unresectable distal malignant biliary obstruction. The median duration of stent patency in the antireflux plastic stent group was 285 d, which was significantly longer than that in the traditional plastic stent group (130 d).