PMID- 36581786
OWN - NLM
STAT- MEDLINE
DCOM- 20230505
LR  - 20240102
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 37
IP  - 5
DP  - 2023 May
TI  - Long-term outcomes of duckbill-type anti-reflux metal stents versus conventional 
      covered metal stents in reinterventions after covered biliary metal stent 
      dysfunction in unresectable pancreatic cancer.
PG  - 3498-3506
LID - 10.1007/s00464-022-09836-0 [doi]
AB  - BACKGROUND: The use of duckbill-type anti-reflux metal stents (DMS) in 
      reinterventions after covered metal stent (CMS) dysfunction has been reported in 
      patients with distal malignant biliary obstruction (MBO). However, the 
      superiority of DMS over conventional CMS (c-CMS) has not been established. 
      Therefore, we conducted this retrospective study to evaluate the long-term 
      efficacy and safety of DMS as a second stent in comparison with c-CMS. METHODS: 
      We investigated consecutive patients with distal MBO due to unresectable 
      pancreatic cancer who underwent reintervention after dysfunction of initial 
      biliary CMS at our institution. We compared causes of recurrent biliary 
      obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and reintervention 
      rates of DMS and c-CMS in this stenting. RESULTS: A total of 76 patients were 
      included (DMS 41 and c-CMS 35). While overall RBO rates were similar between the 
      two groups (46% vs. 63%, p = 0.172), RBO due to non-occlusion cholangitis tended 
      to be less frequent in the DMS group than in the c-CMS group (2% vs. 14%, 
      p = 0.089). Median TRBO was significantly longer in the DMS group (286 days vs. 
      112 days, p = 0.029). DMS was identified as the only significant risk factor for 
      TRBO (hazard ratio, 0.52; p = 0.044). Overall AE rates were significantly lower 
      in the DMS group (2% vs. 23%, p = 0.010), with non-occlusion cholangitis being 
      the most common AE in the c-CMS group. Endoscopic reintervention was successfully 
      performed in all patients in both groups, despite failed stent removal in 15% of 
      patients in DMS group. CONCLUSIONS: DMS was associated with a significantly 
      longer TRBO and lower rate of AEs compared with c-CMS in reinterventions after 
      initial CMS dysfunction. DMS may be preferable to c-CMS as a second stent after 
      biliary CMS dysfunction.
CI  - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business 
      Media, LLC, part of Springer Nature.
FAU - Takeda, Tsuyoshi
AU  - Takeda T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Sasaki, Takashi
AU  - Sasaki T
AUID- ORCID: 0000-0001-7109-9835
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan. sasakit-tky@umin.ac.jp.
FAU - Yamada, Yuto
AU  - Yamada Y
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
AD  - Division of Gastroenterology and Hepatology, Department of Internal Medicine, 
      Omori Medical Center, Toho University, Tokyo, Japan.
FAU - Okamoto, Takeshi
AU  - Okamoto T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Mie, Takafumi
AU  - Mie T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Furukawa, Takaaki
AU  - Furukawa T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Kasuga, Akiyoshi
AU  - Kasuga A
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Matsuyama, Masato
AU  - Matsuyama M
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Ozaka, Masato
AU  - Ozaka M
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
FAU - Sasahira, Naoki
AU  - Sasahira N
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, 
      Japan.
LA  - eng
PT  - Journal Article
DEP - 20221229
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Humans
MH  - *Self Expandable Metallic Stents/adverse effects
MH  - Retrospective Studies
MH  - Stents/adverse effects
MH  - *Pancreatic Neoplasms/complications
MH  - *Cholestasis/etiology/surgery
MH  - *Gastroesophageal Reflux/etiology
MH  - *Cholangitis/etiology/surgery
OTO - NOTNLM
OT  - Anti-reflux metal stent
OT  - Covered metal stent
OT  - Distal malignant biliary obstruction
OT  - Pancreatic cancer
OT  - Recurrent biliary obstruction
EDAT- 2022/12/30 06:00
MHDA- 2023/05/05 06:42
CRDT- 2022/12/29 23:31
PHST- 2022/05/31 00:00 [received]
PHST- 2022/12/16 00:00 [accepted]
PHST- 2023/05/05 06:42 [medline]
PHST- 2022/12/30 06:00 [pubmed]
PHST- 2022/12/29 23:31 [entrez]
AID - 10.1007/s00464-022-09836-0 [pii]
AID - 10.1007/s00464-022-09836-0 [doi]
PST - ppublish
SO  - Surg Endosc. 2023 May;37(5):3498-3506. doi: 10.1007/s00464-022-09836-0. Epub 2022 
      Dec 29.