Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 285-296
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.285
Optimization of biliary drainage in inoperable distal malignant strictures
Esam Elshimi, Wesam Morad, Omar Elshaarawy, Ahmed Attia
Esam Elshimi, Omar Elshaarawy, Ahmed Attia, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebine Elkom 32111, Egypt
Wesam Morad, Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia University, Shebine Elkom 32111, Egypt
Author contributions: Elshimi E, Elshaarawy O and Attia A collected the data and revised the manuscript; Morad W performed the statistical analysis; all authors wrote the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University (IRB number IRB00003413) in April 2015. A consent form was signed by every patient.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interests for all authors.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Esam Elshimi, MBChB, MD, MSc, Doctor, Professor, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Yassin Abdelghaffar Street, Shebine Elkom 32111, Egypt. eelshimi@liver-eg.org
Received: April 9, 2020
Peer-review started: April 9, 2020
First decision: May 26, 2020
Revised: June 3, 2020
Accepted: July 26, 2020
Article in press: July 26, 2020
Published online: September 16, 2020
Abstract
BACKGROUND

Given most patients with distal malignant biliary obstruction present in the non-resectable stage, palliative endoscopic biliary drainage with fully covered metal stent (FCMS) or uncovered metal stent (UCMS) is the only available measure to improve patients’ quality of life. Half covered metal stent (HCMS) has been recently introduced commercially. The adverse effects and stent function between FCMS and UCMS have been extensively discussed.

AIM

To study the duration of stent patency of HCMS and compare it with FCMS and UCMS to optimize biliary drainage in inoperable patients with distal malignant obstruction. Secondary aims in our study included evaluation of patients’ survival and the rates of adverse events for each type of stent.

METHODS

We studied 210 patients and randomized them into three equal groups; HCMS, FCMS and UCMS were inserted endoscopically.

RESULTS

Stent occlusion occurred in (18.6%, 17.1% and 15.7% in HCMS, FCMS and UCMS groups, respectively, P = 0.9). Stent migration occurred only in patients with FCMS (8.6% of patients). Cholangitis and cholecystitis occurred in 11.4% and 5.7% of patients, respectively, in FCMS. Tumor growth occurred only in 10 cases among patients with UCMS after a median of 140 d, sludge occurred in nine, seven and one patients in HCMS, FCMS and UCMS, respectively (P = 0.04).

CONCLUSION

Given the prolonged stent functioning time, the use of HCMS is preferred over the use of UCMS and FCMS for optimizing biliary drainage in patients with distal malignant biliary obstruction.

Keywords: Obstructive jaundice, Endoscopic retrograde cholangio-pancreatography, Half covered metal stent, Fully covered and uncovered metal stents

Core Tip: Given most patients with distal malignant biliary obstruction present in the non-resectable stage, palliative endoscopic biliary drainage with fully covered or uncovered metal stent is the only available measure to improve patients’ quality of life. Half covered metal stent has been recently introduced commercially. The adverse effects and stent function between fully covered metal stent and uncovered metal stent have been extensively discussed. Given the prolonged stent functioning time, the use of half covered metal stent is preferred to the use of uncovered metal stent and fully covered metal stent for optimizing biliary drainage in patients with distal inoperable malignant biliary obstruction.