PMID- 23354625
OWN - NLM
STAT- MEDLINE
DCOM- 20140707
LR  - 20220310
IS  - 1435-5922 (Electronic)
IS  - 0944-1174 (Linking)
VI  - 48
IP  - 11
DP  - 2013 Nov
TI  - Management of dysfunctional covered self-expandable metallic stents in patients 
      with malignant distal biliary obstruction.
PG  - 1300-7
LID - 10.1007/s00535-013-0751-z [doi]
AB  - BACKGROUND: Endoscopic placement of covered self-expandable metallic stents 
      (CSEMSs) is effective for distal malignant biliary obstruction. However, 
      management of dysfunctional CSEMSs has not been established. METHODS: Between 
      March 1998 and July 2007, a total of 74 patients who underwent endoscopic 
      re-interventions for CSEMS dysfunction were analyzed. Second stent insertion 
      (CSEMS or plastic stent) or mechanical cleaning of the occluded CSEMS was 
      performed endoscopically. The period between second stent insertion and stent 
      dysfunction or patient death (time to dysfunction; TTD) was calculated. The 
      cleaned initial CSEMSs were analyzed as second stents. RESULTS: Dysfunction of 
      the second stent occurred in 17 of 37 patients (45.9%) in the CSEMS group, 16 of 
      20 (80.0%) in the plastic stent group, and 13 of 17 (76.5%) in the cleaning 
      group. The median TTD of each group was 176, 57, and 46 days, respectively. The 
      cumulative TTD was significantly higher in the CSEMS group than in the plastic 
      stent and cleaning groups (P = 0.08). From the multivariate analysis, sludge 
      occlusion of the first CSEMS was identified as a significant risk factor for 
      second stent dysfunction (HR, 2.51; 95% CI, 1.19-5.46), and placement of the 
      second CSEMS significantly reduced the risk of dysfunction (HR, 0.39; 95% CI, 
      0.18-0.79). CONCLUSIONS: Insertion of a new CSEMS should be considered as the 
      treatment of choice for the management of dysfunctional CSEMSs.
FAU - Togawa, Osamu
AU  - Togawa O
AD  - Department of Gastroenterology, Graduate School of Medicine, The University of 
      Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
FAU - Isayama, Hiroyuki
AU  - Isayama H
FAU - Tsujino, Takeshi
AU  - Tsujino T
FAU - Nakai, Yousuke
AU  - Nakai Y
FAU - Kogure, Hirofumi
AU  - Kogure H
FAU - Hamada, Tsuyoshi
AU  - Hamada T
FAU - Sasaki, Takashi
AU  - Sasaki T
FAU - Yashima, Yoko
AU  - Yashima Y
FAU - Yagioka, Hiroshi
AU  - Yagioka H
FAU - Arizumi, Toshihiko
AU  - Arizumi T
FAU - Ito, Yukiko
AU  - Ito Y
FAU - Matsubara, Saburo
AU  - Matsubara S
FAU - Yamamoto, Natsuyo
AU  - Yamamoto N
FAU - Sasahira, Naoki
AU  - Sasahira N
FAU - Hirano, Kenji
AU  - Hirano K
FAU - Toda, Nobuo
AU  - Toda N
FAU - Tada, Minoru
AU  - Tada M
FAU - Koike, Kazuhiko
AU  - Koike K
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20130125
PL  - Japan
TA  - J Gastroenterol
JT  - Journal of gastroenterology
JID - 9430794
RN  - 0 (Metals)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cholestasis/diagnostic imaging/etiology/*surgery
MH  - Digestive System Neoplasms/complications
MH  - Endoscopy, Digestive System/methods
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Metals
MH  - Middle Aged
MH  - Prosthesis Design
MH  - Prosthesis Failure
MH  - Radiography
MH  - Recurrence
MH  - Reoperation/adverse effects/methods
MH  - Risk Factors
MH  - *Stents
EDAT- 2013/01/29 06:00
MHDA- 2014/07/08 06:00
CRDT- 2013/01/29 06:00
PHST- 2012/08/11 00:00 [received]
PHST- 2013/01/08 00:00 [accepted]
PHST- 2013/01/29 06:00 [entrez]
PHST- 2013/01/29 06:00 [pubmed]
PHST- 2014/07/08 06:00 [medline]
AID - 10.1007/s00535-013-0751-z [doi]
PST - ppublish
SO  - J Gastroenterol. 2013 Nov;48(11):1300-7. doi: 10.1007/s00535-013-0751-z. Epub 
      2013 Jan 25.