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Sample records for biliary stent placement

  1. Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

    OpenAIRE

    Kim, Jin Hong

    2011-01-01

    Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be...

  2. Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

    International Nuclear Information System (INIS)

    Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention

  3. Treatment of biliary obstruction by percutaneous transhepatic drainage and metallic stent placement

    International Nuclear Information System (INIS)

    Objective: To evaluate the percutaneous transhepatic drainage and biliary stent placement as the treatment of biliary obstruction. Methods: Twenty-three patients with biliary obstruction received percutaneous transhepatic cholangiography and drainage (PTCD). And among the 23, stent placement was performed in 12 patients. Results: All 23 patients jaundice was satisfactorily relieved, and total bilirubin value was decreased from 147.4 pmol/L-648.7 pmol/L, the pre-procedure data, to the post-procedure data at normal level or very close to normal level. In 22 case of malignant biliary obstruction, the survival rate of 3 and 6 months 70% and 60% respectively. the median survival was 6 months. Conclusion: The combination of metallic stent placement and local therapy are effective in the treatment of biliary obstruction which is unable to be cured by surgical procedure. (authors)

  4. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

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    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan [Asan Medical Center, Seoul (Korea, Republic of)

    2004-04-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications.

  5. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    International Nuclear Information System (INIS)

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications

  6. Combined treatment with metallic stent placement and radiotherapy in malignant biliary obstruction

    International Nuclear Information System (INIS)

    To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangio carcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium-192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. In all 22 patients, the duration of stent patency was 5.5(1.3-18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0-8.5 )months and 7.9(4.0-14.7)months respectively in 9 dead patients and 7.7(1.3-21.0)months and 9.5(2.3-23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5% and 35.6 %, respectively. The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement

  7. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Koichiro Tsutsumi; Hironari Kato; Takeshi Tomoda; Kazuyuki Matsumoto; Ichiro Sakakihara; Naoki Yamamoto; Yasuhiro Noma

    2012-01-01

    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice.Recently,therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective,even in patients with surgically altered anatomies.On the other hand,endoscopic partial stent-in-stent (PSIS) placement of selfexpandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible,safe and effective.We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success.This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization,even in patients with surgically altered anatomies.

  8. Temporary Placement of Stent Grafts in Postsurgical Benign Biliary Strictures: a Single Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Vellody, Ranjith; Willatt, Jnonathon M.; Arabi, Mohammad; Cwikiel, Wojciech B [Division of Interventional Radiology, University of Michigan, Ann Arbor (United States)

    2011-11-15

    To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures. Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft. In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days). Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant.

  9. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Medical School of Gachon, Inchon (Korea, Republic of); Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-06-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period.

  10. Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction

    Science.gov (United States)

    Lee, Jae Min; Lee, Sang Hyub; Jang, Dong Kee; Chung, Kwang Hyun; Park, Jin Myung; Paik, Woo Hyun; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong-Tae

    2016-01-01

    Background: Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. Methods: This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. Results: There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. Conclusions: Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction. PMID:26929781

  11. Percutaneous placement of biliary stent for treatment of malignant obstructive jaundice

    International Nuclear Information System (INIS)

    Objective: To introduce the techniques of percutaneous biliary stenting and intraarterial embolization for treatment in patients with hepatocellular carcinoma and biliary obstruction accompanying the evaluation of the therapeutic effect. Methods: Percutaneous biliary metallic stent placement and intraarterial embolization were performed in 12 patients with hepatocellular carcinoma and obstructive jaundice, with mean age of 52.3 years old. Results: Fourteen stents and 3 external biliary drainage catheters were placed in 12 patients. One stent for each was inserted in 7 patients with communication between right and left hepatic ducts; right and left biliary drainages were separately performed with stents or external biliary drainage catheters in 5 with no communication. The serum total bilirubin decreased from 405.3 ± 175.4 μmol/L before the procedure to 188.3 ± 101.5 μmol/L one week after the procedure (P<0.01), and both alkaline phosphatase and transaminase decreased significantly (P<0.05). Percutaneous transarterial chemoembolization for treatment of hepatocellular carcinoma was done one to four time with average of 2.1 times after biliary drainage. There were no severe complications related to the interventional procedure. All patients were followed up with an average of 9.5 months, including 5 patients alive. Conclusions: The percutaneous biliary stenting and intraarterial embolization are safe and effective palliative therapies in patients with hepatocellular carcinoma and obstructive jaundice. It can alleviate jaundice and improve the liver function with longer survival rate

  12. The interventional treatment for biliary re-stenosis after metallic stents placement in patients with malignant obstruction due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To explore the interventional treatment for biliary re-stenosis after metallic stents placement in patients due to cholangiocarcinoma and evaluate its therapeutic effect. Methods: Percutaneous metallic stents placement or combined with continuously infusion arterial chemotherapeutic and chemotherapeutic embolization were performed in 12 patients with biliary re-stenosis using 12 metallic stents. Results: Once stent placement was 100% successful in all 12 cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that in preoperation. Jaundice was reduced satisfactorily in 12 patients. 3 patients were undergone continuously arterial chemotherapeutics infusion and chemotherapeutic embolization 4 weeks after stents placement. Conclusions: Percutaneous replacement of biliary metallic stents was effective and safe for palliation of malignant biliary re-stenosis and would be much better when combined with continuously arterial chemotherapeutics infusion and chemotherapeutic embolization

  13. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    International Nuclear Information System (INIS)

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  14. Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Brian; Story; Michael; Gluck

    2010-01-01

    Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequen...

  15. Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

    OpenAIRE

    Story, Brian; Gluck, Michael

    2010-01-01

    Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in biliary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or “balls”, that fully obstruct the biliary system are uncommon and exceedingly difficult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, ...

  16. Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video).

    Science.gov (United States)

    Shinjo, Kunihiro; Matsubayashi, Hiroyuki; Matsui, Toru; Kawata, Noboru; Uemura, Sunao; Yamamoto, Yusuke; Ono, Hiroyuki

    2016-04-01

    A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs. PMID:26960930

  17. Future developments in biliary stenting

    Directory of Open Access Journals (Sweden)

    Hair CD

    2013-06-01

    Full Text Available Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting.Keywords: plastic stents, self-expandable metal stents, drug eluting stents, bioabsorbable stents, malignant biliary strictures, benign biliary strictures

  18. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture

    Science.gov (United States)

    Centore, Luca; Soreca, Emilio; Corvino, Antonio; Farbo, Vincenzo; Bencivenga, Alfonso

    2016-01-01

    Background This study evaluated the technical and clinical efficacy of percutaneous bilateral biliary stent-in-stent (SIS) deployment technique with a “Y” configuration using open-cell-design stents in type 4 Klatskin tumor patients. Methods Retrospective evaluation ten patients with type IV Bismuth malignant hilar stricture (MHS) treated with percutaneous bilateral “Y” SIS deployment technique placement followed in our institution between March of 2012 and November of 2014. Results Bilateral SIS deployment was technically successful in all patients. One patient (10%) had major complications (episode of cholangitis); one patient (10%) had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in nine (90%) patients. Stent occlusion by tumor overgrowth and sludge formation occurred in two patient (20%). The median survival and stent patency time were 298 and 315 days respectively. Conclusions Percutaneous bilateral metal stenting using a Y-stent is a valid option for the palliative treatment of type 4 Bismuth MHS, improving quality patient’ life. PMID:27034794

  19. Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

    Institute of Scientific and Technical Information of China (English)

    Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Sho Mineta; Yoshiaki Mizuguchi; Yoichi Kawano; Junpei Sasaki; Yoshiharu Nakamura; Takayuki Aimoto; Takashi Tajiri

    2009-01-01

    This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy.Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-Fr tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes onestep insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy.

  20. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series.

    Science.gov (United States)

    Fabbri, C; Luigiano, C; Fuccio, L; Polifemo, A M; Ferrara, F; Ghersi, S; Bassi, M; Billi, P; Maimone, A; Cennamo, V; Masetti, M; Jovine, E; D'Imperio, N

    2011-05-01

    Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been developed as an alternative drainage technique in patients with obstructive jaundice where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Between July 2008 and December 2009, 16 patients (9 men; median age 79 years) with biliopancreatic malignancy, who were candidates for alternative techniques of biliary decompression because ERCP had been unsuccessful, underwent EUS-BD with placement of a transmural or transpapillary partially covered nitinol self-expandable metal stent (SEMS). EUS-assisted cholangiography was successful in all patients, with definition of the relevant anatomy, but biliary drainage was successfully performed in only 12 (75 %) of the 16 patients (9 choledochoduodenostomies with SEMS placement and 3 biliary rendezvous procedures with papillary SEMS placement), with regression of the cholestasis. No major complications and no procedure-related deaths occurred. There was one case of pneumoperitoneum which was managed conservatively. The median follow-up was 170 days. During the follow-up, eight patients of the 12 patients in whom biliary draining was successful died; four are currently alive. None of the patients required endoscopic reintervention. This series demonstrated that EUS-BD with a partially covered SEMS has a high rate of clinical success and low complication rates, and could represent an alternative choice for biliary decompression. PMID:21271507

  1. Portal Vein Occlusion after Biliary Metal Stent Placement in Hilar Cholangiocarcinoma

    OpenAIRE

    Woo, Kyung Hee; Kim, Jin Bae; Chang, Yoon Jung; Kim, Hyo Jung; Baek, Il Hyun; Ko, Jin Seok; Woo, Ji Young; Kim, Hong Dae; Lee, Myung Seok

    2008-01-01

    Acute symptomatic portal vein obstruction related to biliary stenting is an extremely rare but life-threatening complication. This usually occurs in patients with either tumor invasion into the portal vein or pre-existing portal vein thrombus. Therefore, the portal vein should be carefully evaluated before placing a biliary metallic stent in such patients. We describe a case of acute portal vein obstruction after placing metallic biliary stents in a patient with a periductal-infiltrating type...

  2. Portal vein occlusion after biliary metal stent placement in hilar cholangiocarcinoma.

    Science.gov (United States)

    Woo, Kyung Hee; Kim, Jin Bae; Chang, Yoon Jung; Kim, Hyo Jung; Baek, Il Hyun; Ko, Jin Seok; Woo, Ji Young; Kim, Hong Dae; Lee, Myung Seok

    2008-06-01

    Acute symptomatic portal vein obstruction related to biliary stenting is an extremely rare but life-threatening complication. This usually occurs in patients with either tumor invasion into the portal vein or pre-existing portal vein thrombus. Therefore, the portal vein should be carefully evaluated before placing a biliary metallic stent in such patients. We describe a case of acute portal vein obstruction after placing metallic biliary stents in a patient with a periductal-infiltrating type of hilar cholangiocarcinoma. PMID:20485610

  3. Current Status of Biliary Metal Stents

    OpenAIRE

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. ...

  4. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Son, Rak Chae; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi Young [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

  5. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

    International Nuclear Information System (INIS)

    To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

  6. Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

    OpenAIRE

    Tee, Hoi-Poh; James, Martin W; Kaffes, Arthur J

    2010-01-01

    Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation (OLT). Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures. We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT, who had successful temporary placement of a prototype removable covere...

  7. Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

    Institute of Scientific and Technical Information of China (English)

    Hoi-Poh; Tee; Martin; W; James; Arthur; J; Kaffes

    2010-01-01

    Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable m...

  8. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    Tae Hyeon Kim; Seong Hun Kim; Hyo Jeong Oh; Young Woo Sohn; Seung Ok Lee

    2012-01-01

    AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage (EUS-BD) with a fully covered self-expandable metal stent for managing malignant biliary stricture.METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography (ERCP) fails.EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HG) was performed in 9 patients and 4 patients,respectively.RESULTS:The technical and functional success rate was 92.3% (12/13) and 91.7% (11/12),respectively.Using an intrahepatic approach (EUS-HG,n =4),there was mild peritonitis (n =1) and migration of the metal stent to the stomach (n =1).With an extrahepatic approach (EUS-CD,n =10),there was pneumoperitoneum (n =2),migration (n =2),and mild peritonitis (n =1).All patients were managed conservatively with antibiotics.During follow-up (range,1-12 mo),there was re-intervention (4/13 cases,30.7%) necessitated by stent migration (n =2) and stent occlusion (n =2).CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

  9. Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement

    International Nuclear Information System (INIS)

    A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed. At removal, a small contrast leak from the transhepatic tract was seen. Three days later, pneumoperitoneum was found with symptoms of peritoneal irritation and fever. A widely open sphincter of Oddi caused by the metallic stent, accompanied by delayed sealing of the transhepatic tract, may have caused the air and bile leakage into the peritoneal space. This case shows that pneumoperitoneum may occur without ductal tear or bowel injury, with a biliary stent crossing the ampulla of Vater

  10. Placement of multiple metal stents for malignant intrahepatic biliary obstruction via an endoscopic ultrasound-guided choledochoduodenostomy fistula.

    Science.gov (United States)

    Akiyama, Dai; Hamada, Tsuyoshi; Nakai, Yousuke; Isayama, Hiroyuki; Takagi, Kaoru; Mizuno, Suguru; Koike, Kazuhiko

    2015-01-01

    Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a fully-covered self-expandable metal stent (SEMS) is increasingly used as an alternative to failed endoscopic retrograde cholangiopancreatography. An EUS-CDS fistula can provide endoscopists with a new approach route for intrahepatic bile ducts. Here, we present successful placement of multiple SEMS for intrahepatic biliary obstruction via an EUS-CDS fistula. PMID:26462843

  11. Current Status of Biliary Metal Stents.

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-03-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  12. Current Status of Biliary Metal Stents

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  13. Successive breaks in biliary stents.

    Science.gov (United States)

    Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; Guerra, María

    2016-04-01

    A 64 year-old male, was diagnosed with obstructive jaundice due to a well-differentiated pancreatic neuroendocrine tumor with liver metastases. The patient underwent endoscopic placement of covered self-expanding biliary stent (10x60 mm, Hanaro) by ERCP. He was admitted with cholangitis one year later. The following ERCP revealed a fractured stent with loss of the distal end (duodenal) and partial migration of the remaining stent to the common bile duct. The fragmented stent was removed from the common bile duct and a new, similar one was inserted. Four months later the patient was admitted with cholangitis. A new ERCP was done and biliary stent was also fragmented. It was removed and an uncovered stent (Wallflex) was inserted. PMID:27065248

  14. Percutaneous biliary drainage and stenting

    International Nuclear Information System (INIS)

    Full text: Percutaneous transhepatic cholangiography (PTC) is an X-ray or US guided procedure that involves the injection of a contrast material directly into the bile ducts inside the liver to produce pictures of them. If a blockage or narrowing is found, additional procedures may be performed: 1. insertion of a catheter to drain excess bile out of the body or both - internal and external; 2. plastic endoprothesis placement; 3. self-expandable metal stents placement to help open bile ducts or to bypass an obstruction and allow fluids to drain. Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign and malignant obstructions. Internal biliary stents are either plastic or metallic, and various types of each kind are available. Internal biliary stents have several advantages. An external tube can be uncomfortable and have a psychological disadvantage. An internal stent prevents the problems related to external catheters, for example, pericatheter leakage of bile and the need for daily flushing. The disadvantages include having to perform endoscopic retrograde cholangiopancreatography (ERCP) or new PTC procedures to obtain access in case of stent obstruction. Better patency rates are reported with metallic than with plastic stents in cases of malignant obstruction, though no effect on survival is noted. Plastic internal stents are the cheapest but reportedly prone to migration. Metallic stents are generally not used in the treatment of benign disease because studies have shown poor long-term patency rates. Limited applications may include the treatment of patients who are poor surgical candidates or of those in whom surgical treatment fails. Most postoperative strictures are treated surgically, though endoscopic and (less commonly) percutaneous placement of nonmetallic stents has increasingly been used in the past few years. Now there are some reports about use of biodegradable biliary

  15. Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function

    Directory of Open Access Journals (Sweden)

    Tatsuki Ueda

    2016-01-01

    Full Text Available Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST on common bile duct stones (CBDS disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS. Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP. Results. CBDS disappearance was observed in 32 (48.5% of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007 and p<0.001, resp.. Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002. Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

  16. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

    International Nuclear Information System (INIS)

    The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82(65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients' survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective

  17. Clinical analysis of biliary stent placement combined with gamma-knife for the treatment of complex hilar cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Zhi-qiang FENG

    2011-05-01

    Full Text Available Objective To evaluate the therapeutic effect of biliary stent placement combined with gamma-knife for the treatment of complex hilar cholangiocarcinoma.Methods Five patients with type IV hilar cholangiocarcinoma,according to Bismuth classification,combined with stenosis of distant common bile duct were treated with biliary stent placement and gamma-knife.The left intrahepatic bile duct was catheterized under the guidance of ultrasound,followed by catheterization of right intrahepatic bile duct aided by percutaneous transhepatic cholangiography for drainage(PTCD.Three biliary stents were inserted to relieve obstruction.Patients then underwent gamma-knife treatment after subsidence of jaundice,and bilirubin,followed by determination of transaminase and observation of the condition of the tumor.Results Total bilrubin,direct bilrubin and alanine transaminase of patients were 289.38±101.43μmol/L,180.42±72.50μmol/L and 148.80±82.65 U/L respectively before PTCD,and 94.2±20.43μmol/L,62.37±30.41μmol/L and 109.27±45.52 U/L,respectively,7 days after PTCD,and they declined to 27.20±14.60μmol/L,20.58±9.33μmol/L and 59.80±35.18 U/L,respectively,one month after PTCD.Five patients survived for 10,13,14,17 and 24 months,respectively.The median survival time was 15 months.Conclusion The combination of insertion of metallic stents and gamma-knife therapy is a safe and effective treatment for complex hilar cholangiocarcinoma,and this therapeutic strategy may improve survival rate and control the rate of grouth of carcinoma.

  18. Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent

    Institute of Scientific and Technical Information of China (English)

    Antonios Vezakis; Georgios Fragulidis; Constantinos Nastos; Anneza Yiallourou; Andreas Polydorou; Dionisios Voros

    2011-01-01

    Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledocholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists.

  19. Long-Term Placement of Subcutaneous Ruesch-Type Stents for Double Biliary Stenosis in a Living-Donor Liver Transplant Recipient

    International Nuclear Information System (INIS)

    Biliary reconstruction continues to be a major source of morbidity following liver transplantation. The spectrum of biliary complications is evolving due to the increasing number of split-liver and living-donor liver transplantation, which are even associated with a higher incidence of biliary complications. Bile duct strictures are the most common cause of late biliary complications and account for up to 40% of all biliary complications. Optimal therapy for posttransplantation anastomotic biliary strictures remains uncertain and requires a multidisciplinary approach. We report the case of a 54-year-old Caucasian male affected by hepatocarcinoma and hepatitis C-related cirrhosis who underwent right-lobe living-donor liver transplantation from his son complicated by double anastomotic stenosis of the main right hepatic duct and of an accessory biliary duct draining segments 6 and 7 of the graft that was successfully treated by percutaneous transhepatic cholangiography with long-term subcutaneous placement of two internal Ruesch-type biliary stents

  20. Percutaneous placement of self-expandable metallic biliary stents in malignant extrahepatic strictures: indications of transpapillary and suprapapillary methods

    International Nuclear Information System (INIS)

    To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0 . 6 2 ). For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed

  1. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas

    OpenAIRE

    Tsuyuguchi, Toshio; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; Tsukada, Kazuhiro; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Suyama, Masafumi; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; Yoshida, Masahiro; Wada, Keita

    2008-01-01

    Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically. The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents...

  2. Recent Advances of Biliary Stent Management

    International Nuclear Information System (INIS)

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.

  3. Recent advances of biliary stent management.

    Science.gov (United States)

    Kida, Mitsuhiro; Miyazawa, Shiro; Iwai, Tomohisa; Ikeda, Hiroko; Takezawa, Miyoko; Kikuchi, Hidehiko; Watanabe, Maya; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2012-01-01

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations. PMID:22563289

  4. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer

    OpenAIRE

    Decker, Christopher; Christein, John D.; Phadnis, Milind A.; Mel Wilcox, C.; Varadarajulu, Shyam

    2011-01-01

    Background It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression. Methods This was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their...

  5. Stenting in Malignant Biliary Obstruction.

    Science.gov (United States)

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed. PMID:26431598

  6. Improving results of stent placement in the esophagus and biliary tract: clinical studies

    NARCIS (Netherlands)

    van Boeckel, P.G.A.

    2011-01-01

    Main conclusions from this thesis Part I Esophagus Benign esophageal ruptures or leaks - Covered stents placed for a period of 6 weeks are effective and safe. Stent choice should to a large extent depend on expected risks of stent migration, particularly when SEPS and FSEMS are used, and tissue in-

  7. Metallic stents for management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction

  8. Metallic stents for management of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hee; Do, Young Soo; Byun, Hong Sik; Kim, Kie Hwan; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1992-11-15

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction.

  9. Risk of Post-ERCP Pancreatitis after placement of Covered versus Uncovered Self-Expandable Biliary Metal Stents: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2008-09-01

    Full Text Available Background Self-expandable metal stents are commonly used in the management of malignant biliary obstruction due to higher patency rates compared to plastic stents. Development of covered self-expandable metal stents has led to extended stent patency compared to uncovered self-expandable metal stents. However, there are concerns that deployment of covered self-expandable metal stents may be associated with higher risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis, acute cholecystitis and stent migration. Objective We performed this meta-analysis to assess the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events (acute cholecystitis and stent migration with biliary covered self-expandable metal stents compared to uncovered self-expandable metal stents. We also assessed the proportion of stent patency at 6 and 12 months between the two groups. Methods We searched MedLine, EMBASE, Cochrane database, ISI Web of Science and Scopus from January 1989 through June, 2014, to identify randomized controlled trials and observational studies that provided data on the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events following the placement of covered self-expandable metal stents versus uncovered self-expandable metal stents in patients with biliary obstruction. The Mantel–Haenszel method was used to pool data of post-endoscopic retrograde cholangio- pancreatography pancreatitis, acute cholecystitis, stent migration and proportion of stent patency over 6 and 12 months into fixed or random effect model of meta-analyses. Odds ratio was used to generate an overall effect estimate of the outcome. Results Eight studies (6 randomized controlled trials and 2 observational studies with a total of 1078 patients were included in the meta-analysis. The pooled odds ratio with 95% confidence intervals for risk of post-endoscopic retrograde cholangio

  10. Malignant biliary obstruction treated with metallic stents

    International Nuclear Information System (INIS)

    Purpose: The outcome of 33 patients with malignant biliary obstruction treated with metallic stents is presented. Materials and methods: Thirty-eight biliary metallic stents were placed in 33 patients with malignant biliary obstruction. They were 52-71 years old (mean = 61.7); 23 were male and 10 were female. The biliary obstruction was caused by biliary carcinoma (n = 16), pancreatic carcinoma (n = 2), hepatoma (n = 2), metastasis in liver (n = 3) and lymph node metastasis (n = 10). Six types and 38 metallic stents were used. After stentering, 3 cases were treated with intrastent brachytherapy, 7 cases treated with external radiotherapy and 2 patients treated with interventional radiology. Patients were followed for 6-28 months, mean 11 months. Results: Stent placement was successful in all 33 cases. The same time, 4 patients were treated with plastic tube for external drainage only. The successful rate was 90%. Twenty-nine patients were placed in one time, 4 cases began with plastic tube which was replaced with metallic stents after 1-2 weeks. Nine had metallic stents and plastic tube, because of complicated obstruction. The external drainage catheters were removed after 15-200 days. Three patients had stents crossing the ampulla. In 28 cases (84.85%), jaundice was reduced satisfactorily while in 5 cases with complicated biliary obstruction, the result was unsatisfactory. The median survival was 7 months. After stentering, 12 cases were treated with locat chemotherapy, brachytherapy or radiotherapy. The median survival period was 10 months. Conclusion: The metallic stent provides good palliative drainage and is well tolerated by patients. It improves the survival rate when combined with radiotherapy, brachytherapy and chemotherapy in patients with malignant biliary obstruction

  11. Future developments in biliary stenting

    OpenAIRE

    Hair CD; Sejpal DV

    2013-01-01

    Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected...

  12. Lethal post-endoscopic retrograde cholangiopancreatography pancreatitis following fully covered metal stent placement in distal biliary obstruction due to unresectable cholangiocarcinoma.

    Science.gov (United States)

    Itoi, Takao; Tsuchiya, Takayoshi; Tanaka, Reina; Ikeuchi, Nobuhito; Sofuni, Atsushi

    2013-05-01

    Biliary self-expandable metallic stent (SEMS) is the preferred and first-line therapy for unresectable malignant biliary obstruction. To date, several reports have revealed the relatively high incidence of acute complications such as pancreatitis and cholecystitis due to mechanical stent compression. In the present case, we encountered fatal pancreatitis following fully covered metal stent placement. An 85-year-old man had middle bile duct strictures due to cholangiocarcinoma. A 10-mm diameter fully covered SEMS was placed across the papilla for biliary decompression. Laboratory data and physical evidence the following day revealed acute pancreatitis. Therefore, antibiotics and protein degeneration enzyme inhibitors were given. However, his condition did not improve. Two days after the procedure, we removed the stent and returned him to his original hospital. Serum amylase level decreased below 400 mg/dL 6 h after the procedure. However, the acute pancreatitis worsened. Although we treated the patient in the intensive care unit, he died 32 days after the second admission.

  13. Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

    Directory of Open Access Journals (Sweden)

    Kei Ito

    2010-01-01

    Full Text Available An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a duodenal metal stent was placed across the stricture of the duodenum. No procedure-related complications occurred. Neither migration nor obstruction of the two stents was observed during the three months followup period. Combination of ESBD using a fully covered metal stent and duodenal stenting is a feasible technique and possibly a less invasive treatment option for malignant biliary and duodenal obstruction compared to surgery.

  14. Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sun Jun; Bae, Jae Ik; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu Sung; Lee, Jae Hee; Kim, Young Chul [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2012-11-15

    To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

  15. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available Coronary Angioplasty Stent Placement Shawnee Mission Heart & Vascular Center, Shawnee Mission, Kansas February 19, 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center ...

  16. Endoscopic stent placement for patients with malignant biliary obstruction%恶性胆道梗阻患者内镜下支架治疗分析

    Institute of Scientific and Technical Information of China (English)

    汪祺; 张焰平; 汪文生; 汪胡根; 李敏

    2012-01-01

    Objective To explore the clinical value of endoscopic biliary stent placement for patients with malignant biliary obstruction (MBO). Methods Twenty - three MBO patients received placement of plastic or metal stents endoscopically. Complications were observed after the operation and the total serum bilirubins were compared. Results All the 23 MBO patients had 23 successful endoscopic stent placement with only 2 failures. Three patients underwent placement a second time. The overall success rate was 91.3%. The overall efficacy rate of eliminating jaundice was 86.9% and the incidence rate of complications was 8.7%. The mean survival time of all patients was 6.9 months. Conclusion Endoscopic biliary stent placement is effective in reducing jaundice caused by MBO with less complications, and it can improve the life quality of patients.%目的 探讨内镜下支架置入对恶性胆道梗阻患者的临床应用价值.方法 23例恶性胆道梗阻患者,内镜下置入胆道塑料或金属支架,观察术后并发症以及手术前后胆红素变化.结果 23例恶性胆道梗阻患者中,内镜下植入支架成功23次,2例未能成功,3例2次更换支架,操作成功率为91.3%,消除黄疸总有效率为86.9%,并发症发生率为8.7%,平均存活期约为6.9个月.结论 经内镜胆道支架置入术可解决恶性胆道梗阻引起的黄疸,且创伤小、并发症少,能提高患者生存质量.

  17. Risk of Post-ERCP Pancreatitis after placement of Covered versus Uncovered Self-Expandable Biliary Metal Stents: A Systematic Review and Meta-Analysis

    OpenAIRE

    Yaseen Alastal; Tariq Hammad; Muhammad Ali Khan; Khalil, Basmah W.; Sobia Khan; Mohammad Kashif Ismail; Ali Nawras; Aijaz Sofi

    2008-01-01

    Background Self-expandable metal stents are commonly used in the management of malignant biliary obstruction due to higher patency rates compared to plastic stents. Development of covered self-expandable metal stents has led to extended stent patency compared to uncovered self-expandable metal stents. However, there are concerns that deployment of covered self-expandable metal stents may be associated with higher risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis, acute...

  18. Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

    OpenAIRE

    Kei Ito; Naotaka Fujita; Yutaka Noda; Go Kobayashi; Takashi Obana; Jun Horaguchi; Shinsuke Koshita; Yoshihide Kanno; Takahisa Ogawa; Yuhei Kato; Yasunobu Yamashita

    2010-01-01

    An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a ...

  19. Temporary placement of fully covered metal stent for benign biliary strictures%全覆膜金属支架治疗良性胆道狭窄的初步研究

    Institute of Scientific and Technical Information of China (English)

    冀明; 王拥军; 李鹏; 吕福靖; 李巍; 张澍田

    2011-01-01

    目的 探讨全覆膜胆道金属支架治疗良性胆道狭窄的安全性及其疗效.方法 36例良性胆道狭窄患者行全覆膜胆道金属支架置入术治疗,术后每1~2个月接受1次门诊随访,观察并发症发生及胆道狭窄改变情况.结果 36例均一次性成功置入全覆膜胆道金属支架,未出现与操作相关的严重并发症,支架放置3~6个月后全部成功拔除,其中28例(77.8%)良性胆道狭窄消失.结论 置入全覆膜胆道金属支架治疗良性胆道狭窄是安全的,近期疗效显著.%Objective To explore the efficacy and safety of temporary placement of fully covered metal stent in the treatment of benign biliary strictures.Methods Fully covered metal stents were placed in 36 patients with benign biliary strictures.All patients were followed up every 1-2 months and the stents were removed when adequate biliary drainage was achieved.Results Resolution of the benign biliary strictures was achieved in 28 of 36 patients (77.8% ).All fully covered metal stents were removed successfully.Complications were observed in 3 patients (8.3%) after stent placement and in 1 (2.8% ) after stent removal.Conclusion Temporary placement of fully covered metal stents for benign biliary strictures is safe and efficacious.Further investigation is required to longer follow-up.

  20. ENDOSCOPIC STENT FOR PALLIATING MALIGNANT AND BENIGN BILIARY OBSTRUCTION

    Institute of Scientific and Technical Information of China (English)

    缪林; 范志宁; 季国忠; 文卫; 蒋国斌; 吴萍; 刘政; 黄光明

    2004-01-01

    Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included paplilla of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4), choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1). The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%, 58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively. Early complication included post-ERCP pancreatitis and cholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient's living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.

  1. Metallic stents in malignant biliary obstruction

    International Nuclear Information System (INIS)

    Purpose. Retrospective analysis of our results with metallic stent placement for malignant biliary strictures. We sought to determine parameters that influence stent patency. Methods. A total of 95 Wallstents were implanted in 65 patients (38 men, 27 women; mean age, 65.1 years) with malignant biliary obstruction. Serum bilirubin levels were assessed in 48 patients; the mean value prior to intervention was 15.0 mg/dl. Results. In 12 patients (21%) complications occurred as a result of percutaneous transhepatic drainage. Stent implantation was complicated in 13 patients, but was possible in all patients. A significant decrease in bilirubin level was seen in 83.3% of patients following stent implantation. Approximately 30% of patients developed recurrent jaundice after a mean 97.1 days. In 9 patients (15%) the recurrent jaundice was caused by stent occlusion due to tumor growth. The mean follow-up was 141.8 days, the mean survival 118.7 days. Patients with cholangiocarcinomas and gallbladder carcinomas had the best results. Worse results were seen in patients with pancreatic tumors and with lymph node metastases of colon and gastric cancers. Conclusions. The main predictive factors for occlusion rate and survival are the type of primary tumor, tumor stage, the decrease in bilirubin level, and the general condition of the patient

  2. Metal biliary stent placement for hilar cholangiocarcinoma%胆道金属支架置入治疗肝门部胆管癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    石力; 汤礼军; 汪涛; 张炳印; 李运明; 陈涛; 庞勇; 田伏洲

    2012-01-01

    To assess the clinical application value of biliary stent placement for hilar cholangiocarcinoma via percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of 75 patients with hilar cholangiocarcinoma undergoing metal biliary stent placement were retrospectively analyzed. Results: In PTBD group, stent placement was performed in 29 cases and stents were successfully placed in 26 of the 29 cases (89.7%), the incidence of complications was 6.5%, and the median survival time was 26 weeks respectively. In ERCP group, stents were successfully placed in 38 of the 44 cases (86.4%), the incidence of complications was 13.6%, and the median survival time was 28 weeks respectively. The median survival time of both the unilateral placement group (29 cases) and bilateral placement group (35 cases) was 28 weeks. Conclusion: Biliary stent placement for hilar cholangiocarcinoma can achieve demonstrable efficacy either by PTBD or ERCP. Unilateral placement is preferred when using PTBD, while bilateral placement is recommended when performing ERCP.%目的:探讨经皮经肝胆道引流(PTBD)及经内镜逆行胰胆管造影(ERCP)置入胆道支架治疗肝门部胆管癌的临床应用价值.方法:对75例行金属胆道支架置入的肝门部胆管癌患者的临床资料进行回顾性分析.结果:PTBD组31例患者中29例实施支架放置,26例(89.7%)成功置入支架并发症发生率为6.5%,中位生存时间为26周;ERCP组44例患者中38例(86.4%)成功置入支架,并发症发生率为13.6%,中位生存时间为28周.29例单侧支架置入者和35例双侧支架置入者中位生存时间均为28周.结论:经PTBD及经ERCP的胆道支架置入对肝门部胆管癌均可获得良好的治疗效果.以PTBD方式放置时可采用单侧置入,以ERCP方式放置时应进行左右侧双支架置入.

  3. Comparison of the Efficacy of Endoscopic vs.Percutaneous Transhepatic Biliary Metal Stent Place-ment for the Treatment of Malignant Extrahepatic Biliary Obstruction%经内镜与经皮肝穿刺胆道金属支架置入治疗肝外胆管恶性梗阻的对比分析

    Institute of Scientific and Technical Information of China (English)

    吴明浩

    2014-01-01

    【目的】探讨应用不同方式胆道金属支架置入治疗肝外胆管恶性梗阻的效果,为临床上选择更适当的方法治疗晚期恶性梗阻性黄疸提供依据。【方法】回顾性分析本院2009年1月至2013年1月经内镜胆道金属支架置入术(EMBD)治疗肝外胆管恶性梗阻患者80例(EMBD组)及经皮肝穿刺胆管造影(PTC)胆道金属支架置入术治疗肝外胆管恶性梗阻患者80例(PTC组)的临床资料。比较两组的手术成功率、术后并发症发生率、支架通畅时间及患者生存期。【结果】两组患者术后肝功能均有明显改善,两组之间比较总胆红素(TB)、碱性磷酸酶(ALP)及谷氨酰基转移酶(GGT)下降程度无显著性差异(P>0.05),PTC组的手术成功率高于 EMBD组,但并发症的发生率明显高于 EMBD组(P<0.05)。两组病人术后支架通畅时间及生存期比较无显著性差异(P >0.05)。【结论】对于肝外胆道恶性梗阻患者可首选 EMBD,如手术失败可考虑经PTC途径行胆道支架置入。%[Objective]To explore the efficacy of different ways of metal stent placement for the treatment of advanced malignant obstructive jaundice in order to provide the basis for selecting better method for clinical treat-ment.[Methods]Clinical data of 80 patients with malignant extrahepatic biliary obstruction undergoing endoscopic biliary metal stent placement and 80 patients with malignant extrahepatic biliary obstruction undergoing percutane-ous transhepatic biliary metal stent placement in our hospital from Jan.2009 to Jan.2013 were analyzed retrospec-tively.The achievement ratio of operation,the incidence of postoperative complications,the unobstructed time of stents and the survival time of patients between two groups were compared.[Results]Liver function of two groups after operation was significantly improved.There was no significant difference in the decline of total

  4. A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

    OpenAIRE

    Choi, Jae Myoung; Kim, Jin Hong; Kim, Soon Sun; Yu, Jun Hwan; Hwang, Jae Chul; Yoo, Byung Moo; Park, Sang Heum; Kim, Ho Gak; Lee, Dong Ki; Ko, Kang Hyun; Yoo, Kyo Sang; Park, Do Hyun

    2012-01-01

    Background/Aims The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent. Methods We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the techn...

  5. Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations.

    OpenAIRE

    Canena, J; Liberato, M; Horta, D; Romão, C.; Coutinho, A

    2013-01-01

    BACKGROUND: Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. METHODS: ...

  6. Role of Fully Covered Self-Expandable Metal Stent for Treatment of Benign Biliary Strictures and Bile Leaks

    OpenAIRE

    Pausawasadi, Nonthalee; Soontornmanokul, Tanassanee; Rerknimitr, Rungsun

    2012-01-01

    Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant bili...

  7. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk; Kim, Chan Soo; Lee, Kyung Soo; Choi, See Sung; Won, Jong Jin; Kim, Haak Cheul; Chae, Kwon Mook [Wonkwang University School of Medicine, Iri (Korea, Republic of)

    1994-04-15

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected.

  8. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    International Nuclear Information System (INIS)

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected

  9. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

    Directory of Open Access Journals (Sweden)

    Vleggaar Frank P

    2009-12-01

    Full Text Available Abstract Background Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred. Methods A systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical success and complications. Results In total, 47 studies (1116 patients on outcome of stent placement were identified. No randomized controlled trials (RCTs, one non-randomized comparative studies and 46 case series were found. Technical success was 98,9% for uncovered self-expandable metal stents (uSEMS, 94,8% for single plastic stents and 94,0% for multiple plastic stents. Overall clinical success rate was highest for placement of multiple plastic stents (94,3% followed by uSEMS (79,5% and single plastic stents (59.6%. Complications occurred more frequently with uSEMS (39.5% compared with single plastic stents (36.0% and multiple plastic stents (20,3%. Conclusion Based on clinical success and risk of complications, placement of multiple plastic stents is currently the best choice. The evolving role of cSEMS placement as a more patient friendly and cost effective treatment for benign biliary strictures needs further elucidation. There is a need for RCTs comparing different stent types for this indication.

  10. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... of the bare metal stent versus the drug-coated stents is an ongoing debate. And I think ... that with putting in a bunch of drug-coated stents, and it looks very pretty when we’ ...

  11. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

    OpenAIRE

    Vleggaar Frank P; van Boeckel Petra GA; Siersema Peter D

    2009-01-01

    Abstract Background Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred. Methods A systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical succe...

  12. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... put in, versus medicated or what’s known as drug-eluding stents. And there has been a lot ... Both bare metal stents and medicated stents, or drug-eluting stents, have their role, and we often ...

  13. Palliative Treatment of Obstructive Jaundice in Patients with Carcinoma of the Pancreatic Head or Distal Biliary Tree. Endoscopic Stent Placement vs. Hepaticojejunostomy

    Directory of Open Access Journals (Sweden)

    Marius Distler

    2010-11-01

    Full Text Available Context Palliative procedures play an important role in the treatment of malignancies of the pancreatic head/distal biliary tree, as only 20-30% can be cured by surgical resection. Objective We sought to determine if surgical or non-surgical management was the most appropriate therapy for the treatment of obstructive jaundice in the palliative setting. Setting High volume center for pancreatic surgery. Patients Analysis of 342 palliatively-treated patients with adenocarcinoma of the pancreatic head or the distal biliary tree. Main outcome measures We studied the outcomes with regard to treatment, complications and survival times. Design The patients were divided into three groups. Group 1: e ndoscopic bile duct endoprosthesis (no. 138, 56%; Group 2: preoperative stenting followed by laparotomy (if patients were found to be unresecta ble, palliative hepaticojejunosto my was performed (no. 68, 28%; Group 3: hepaticojejunostomy without preoperative stenting (no. 41, 16%. We also determined th e frequency of re-hospitalizatio n for recurrent jaundice. Results Two hundred and sixty-one (76% patients showed obstructive jaundice. Mortal ity in Groups 1, 2, and 3 was 2.2%, 0%, and 2.4%, respectively and morbidity was 5. 1%, 17.6%, and 14.6%, respectively . The mean interval between stent exchanges was 70.8 days. Median surv ival for patients treated only with an endoscopic stent (Group 1 was significantly shorter than that of patients who were first stented and subsequently treated with hepaticojejunostomy (Group 2 (5.1 vs . 9.4 months; P<0.001. Conclusions Hepaticojejunostomy can be performed with satis factory operative results and acceptable morbidity. Considering that biliary stents can occlude, a hepaticojejunosto my may be superior to endoscopi c stenting; hepaticojejunostomy should be especially favored in pati ents whose disease is fi rst found to be unresectable intraoperatively.

  14. Percutaneous cholangioscopy in obstructed biliary metal stents

    International Nuclear Information System (INIS)

    Purpose. To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. Methods. Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethane-covered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. Results. In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n=1) to subtotal (n=8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. Conclusion. PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months

  15. Y-Shaped Bilateral Self-Expandable Metallic Stent Placement for Malignant Hilar Biliary Obstruction: Data from a Referral Center for Palliative Care

    Directory of Open Access Journals (Sweden)

    R. Di Mitri

    2014-01-01

    Full Text Available Background and Aim. Malignant hilar strictures are a clinical challenge because of the current therapeutic approach and the poor prognosis. In recent years, self-expandable metallic stents have proven more effective than plastic stents for palliation of malignant hilar strictures, with the bilateral stent-in-stent technique registering a high success rate. We report our experience with Y-shaped endoscopic self-expandable metallic stents placement for treatment of advanced malignant hilar strictures. Methods. From April 2009 to August 2012, we prospectively collected data on patients treated with Y-shaped SEMS placement for advanced malignant hilar carcinoma. Data on technical success, clinical success, and complications were collected. Results. Twenty patients (9 males were treated (mean age 64.2 ± 15.3 years. The grade of malignant hilar strictures according to the Bismuth classification was II in 5 patients (25%, IIIa in 1 (5%, and IV in 14 (70%. The mean bilirubin level was 14.7 ± 4.9 mg/dL. Technical success was achieved in all patients, with a significant reduction in bilirubin levels (2.9 ± 1.7 mg/dL. One patient experienced cholangitis as early complication, while in 2 patients stent ingrowth was observed. No stents migration was recorded. There was no procedure-related mortality. At the end of the follow-up (7.1 ± 3.1 months, 13 of the 20 patients (65% had died. Conclusions. Our experience confirms endoscopic bilateral self-expandable metallic stents placement with stent-in-stent technique (Y-shaped configuration as a feasible, effective, and safe procedure for palliation of unresectable malignant hilar strictures.

  16. Contrast-free endoscopic stent insertion in malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection.METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction,unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent,7 to 15 cm long, was finally inserted over the guide wire/guiding catheter by a pusher tube system.RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels,was achieved in all patients.CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.

  17. Placement of Covered Self-Expandable Metal Biliary Stent for the Treatment of Severe Postsphincterotomy Bleeding: Outcomes of Two Cases

    Directory of Open Access Journals (Sweden)

    Marta Di Pisa

    2010-01-01

    Full Text Available We report two cases of severe postsphincterotomy bleeding in an adult and a pediatric patient treated, as first options, with available techniques to induce hemostasis without success. Because of persisting bleeding, an expandable, partially covered, metallic stent was placed into the choledocho to mechanically compress the bleeding site. The bleeding was stopped. In the following days, both patients remained hemodynamically stable with no further episodes of bleeding. We believe that the application of a covered metallic stent in a severe postendoscopic-sphincterotomy bleeding, refractory to injection therapy, should be considered to avoid additional interventions, which carry a higher risk of complications, even in pediatric patients.

  18. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention

    OpenAIRE

    Kwon, Chang-Il; Lehman, Glen A.

    2016-01-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, ...

  19. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... target lesion. Now with the stents being as flexible as they are, we can pretty much get to anywhere we want. The issue of the bare metal stent versus the drug-coated stents is an ongoing debate. ...

  20. Placement of Covered Self-Expandable Metal Biliary Stent for the Treatment of Severe Postsphincterotomy Bleeding: Outcomes of Two Cases

    OpenAIRE

    Davide Cintorino; Luca Barresi; Ilaria Tarantino; Marta Di Pisa; Mario Traina

    2010-01-01

    We report two cases of severe postsphincterotomy bleeding in an adult and a pediatric patient treated, as first options, with available techniques to induce hemostasis without success. Because of persisting bleeding, an expandable, partially covered, metallic stent was placed into the choledocho to mechanically compress the bleeding site. The bleeding was stopped. In the following days, both patients remained hemodynamically stable with no further episodes of bleeding. We believe that the app...

  1. Partially Covered Self-Expandable Metal Stents versus Polyethylene Stents for Malignant Biliary Obstruction: A Cost-Effectiveness Analysis

    OpenAIRE

    Barkun, Alan N; Viviane Adam; Myriam Martel; Khalid AlNaamani; Moses, Peter L

    2015-01-01

    BACKGROUND/OBJECTIVE: Partially covered self-expandable metal stents (SEMS) and polyethylene stents (PES) are both commonly used in the palliation of malignant biliary obstruction. Although SEMS are significantly more expensive, they are more efficacious than PES. Accordingly, a cost-effectiveness analysis was performed.METHODS: A cost-effectiveness analysis compared the approach of initial placement of PES versus SEMS for the study population. Patients with malignant biliary obstruction unde...

  2. Photodynamic therapy for occluded biliary metal stents

    Science.gov (United States)

    Roche, Joseph V. E.; Krasner, Neville; Sturgess, R.

    1999-02-01

    In this abstract we describe the use of photodynamic therapy (PDT) to recanalize occluded biliary metal stents. In patients with jaundice secondary to obstructed metal stents PDT was carried out 72 hours after the administration of m THPC. Red laser light at 652 nm was delivered endoscopically at an energy intensity of 50 J/cm. A week later endoscopic retrograde cholangiogram showed complete recanalization of the metal stent.

  3. Functional Self-Expandable Metal Stents in Biliary Obstruction

    OpenAIRE

    Kwon, Chang-Il; Ko, Kwang Hyun; Hahm, Ki Baik; Kang, Dae Hwan

    2013-01-01

    Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each st...

  4. Modified gianturco biliary stent in benign and malignant obstruction: Results of long-term follow up

    International Nuclear Information System (INIS)

    Modified biliary gianturco stents were placed in 27 patients with obstructive jaundice. From July 1990 to October 1992, 46 two-seven connected stents of 8-12 mm in diameter (Myungsung Meditech, Seoul, Korea) were placed in 5 patients with benign biliary stricture and 22 patients with malignant biliary stricture in three university hospitals; 12 in Chonbuk National University Hospital, 12 in Wonkwang University Hospital, and 3 in Chonnam National University Hospital. Nineteen were men and eight were women, ranged in age from 34 to 76 years (average, 55 years). The stents were placed percutaneously through a transhepatic approach using a 8.5 Fr. introducing sheath. All stents were placed successfully without any technical failures or procedural morbidity or mortality. All patients complained dull abdominal pain for 1 to 3 days after the stent placement. In a follow-up period of 7-46 weeks, reocclusions were observed in one of the patients with benign stricture (20%) and three of the patients with malignant stricture (16%). Two patients with recurrent jaundice due to the obstruction of the stent were treated with placement of additional stent, one patient was treated with external catheter drainage. Migration of stent occurred in one patient. The application of the expandable biliary metallic stent is suggested as an effective treatment for benign and malignant biliary obstructive jaundice

  5. Modified gianturco biliary stent in benign and malignant obstruction: Results of long-term follow up

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jin Young; Song, Ho Young; Han, Hyun Young; Han, Young Min; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul; Roh, Byung Suk; Kim, Jae Kyu [College of Medicine, Chonbuk National University, Chonju (Korea, Republic of)

    1993-05-15

    Modified biliary gianturco stents were placed in 27 patients with obstructive jaundice. From July 1990 to October 1992, 46 two-seven connected stents of 8-12 mm in diameter (Myungsung Meditech, Seoul, Korea) were placed in 5 patients with benign biliary stricture and 22 patients with malignant biliary stricture in three university hospitals; 12 in Chonbuk National University Hospital, 12 in Wonkwang University Hospital, and 3 in Chonnam National University Hospital. Nineteen were men and eight were women, ranged in age from 34 to 76 years (average, 55 years). The stents were placed percutaneously through a transhepatic approach using a 8.5 Fr. introducing sheath. All stents were placed successfully without any technical failures or procedural morbidity or mortality. All patients complained dull abdominal pain for 1 to 3 days after the stent placement. In a follow-up period of 7-46 weeks, reocclusions were observed in one of the patients with benign stricture (20%) and three of the patients with malignant stricture (16%). Two patients with recurrent jaundice due to the obstruction of the stent were treated with placement of additional stent, one patient was treated with external catheter drainage. Migration of stent occurred in one patient. The application of the expandable biliary metallic stent is suggested as an effective treatment for benign and malignant biliary obstructive jaundice.

  6. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... But there is clearly a huge body of data that shows that tobacco use is associated with ... medicated stents. I hear they’re bad.” The data that has come out since then has showed ...

  7. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... not to just ignore any kind of symptoms. Diabetics, in particular, are a subclass of patients who ... vessel disease or multiple vessel blockages, or a diabetic, we think that the drug-eluting stents are ...

  8. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... the equipment that we use from the early days has undergone a sea change. The catheters that ... the stent design has improved from the early days when they were very difficult to deploy and ...

  9. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... care of the intravenous medications and any other medicines that need to be administered in monitoring his ... put in, versus medicated or what’s known as drug-eluding stents. And there has been a lot ...

  10. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... have accessed the femoral artery, which is the big blood vessel in the leg, through which we ... getting to the point where if it’s a big artery, a bare metal stent will work, a ...

  11. Coronary Angioplasty Stent Placement

    Science.gov (United States)

    ... 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center in Merriam, ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ...

  12. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center in Merriam, ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ...

  13. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... the opening of the blood vessel. It’s a collagen plug, and that will help seal the opening. ... stent should be on Plavix or a similar type of anti-platelet drug lifelong. One of the ...

  14. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... a big artery, a bare metal stent will work, a smaller artery or in some of the ... the equipment that we use from the early days has undergone a sea change. The catheters that ...

  15. Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer

    OpenAIRE

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Nakai, Yousuke; Sasahira, Naoki; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2012-01-01

    Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructio...

  16. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention.

    Science.gov (United States)

    Kwon, Chang-Il; Lehman, Glen A

    2016-03-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations. PMID:27000422

  17. Endoscopic placement of biliary metal stent drainage combined with endoscopic naso-biliary drainage in the treatment of malignant biliary obstruction%经内镜放置胆管金属支架联合鼻胆管引流治疗恶性胆管梗阻

    Institute of Scientific and Technical Information of China (English)

    刘华; 周莹群; 徐选福; 赵严; 冯百岁

    2015-01-01

    Objective To evaluate the effect of biliary mental stent drainage combined with endoscopic naso-biliary drainage in the treatment of malignant biliary obstruction. Methods One hundred and thirteen patients with maligmant biliary obstruction who had lost the chance for surgery, were treated with biliary stent through endoscopic retrograde cholangiopancreatography:48 patients were treated with endoscopic retrograde biliary drainage with plastic stent, 30 pa-tients were treated with endoscopic retrograde biliary drainage with mental stent, and 37 patients were treated with endo-scopic metal stent drainage combined with naso-biliary drainage. Results The levels of ALT, TBIL, DBIL and AKP of pre-stenting were much higher than that of post-stenting ( P0 . 05 ) . The re-blockage rates of metal stent group and metal stent drainage combined with naso-biliary drainage group three months after surgey were much lower than plastic stent group ( P0 . 05 ) . There was no difference of successful rate between plastic stent group and metal stent group and metal stent drainage combined with naso-biliary drainage group ( P>0 . 05 ) . Early complication of plastic stent group was much higher than that of met-al stent drainage combined with naso-biliary drainage group ( P0.05);术后3个月内金属支架组和金属支架联合鼻胆管组再堵塞的发生率明显低于塑料支架组(P0.05);塑料支架组的手术成功率与金属支架组及金属支架联合鼻胆管组相比,差异无统计学意义(P>0.05),塑料支架组的早期并发症发生率明显高于金属支架联合鼻胆管组,差异有统计学意义(P<0.05)。结论经内镜逆行胰胆管造影下放置胆管金属支架联合鼻胆管对于恶性胆管梗阻有确切的引流效果。

  18. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients

    OpenAIRE

    Liberato Manuel José; Canena Jorge Manuel

    2012-01-01

    Abstract Background Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS) and plastic stents (PS).We also compared unilateral and bilateral stent placement according to the Bismuth classification. Methods Data on 480 patients receiving endoscopic biliary drainage for hilar ch...

  19. Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

    International Nuclear Information System (INIS)

    Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting

  20. Radiotherapy Prolongs Biliary Metal Stent Patency in Malignant Pancreatobiliary Obstructions

    OpenAIRE

    Park, Semi; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Chung, Jae Bock; Song, Si Young

    2013-01-01

    Background/Aims Biliary stenting is the most effective decompressive method for treating malignant biliary obstructive jaundice. Although the main cause of stent occlusion is tumor growth, few studies have investigated whether stent patency is affected by the combination of cancer-treatment modalities. The aim of this study was to evaluate the effects of local radiotherapy on metal-stent patency in patients with malignant biliary obstruction. Methods Patients who underwent self-expandable bil...

  1. Evaluation of different percutaneous modalities for managing malfunctioning biliary stents

    OpenAIRE

    M. Alwarraky; A. Aljaky; E. Tharwa; Aziz, A.

    2015-01-01

    Background: There is no consensus regarding optimal management of biliary metal stent occlusion. Aim: To evaluate the efficacy of different percutaneous methods for managing biliary metal stent occlusion. Patients and methods: Thirty-eight patients were included in the study. Metal biliary stent occlusions were managed by insertion of another metal stent in 18 patients (group 1), insertion of an internal–external catheter in 15 patients (group 2), and mechanical cleaning in 5 patients (...

  2. Effectiveness and Safety of Endoscopic Treatment of Benign Biliary Strictures Using a New Fully Covered Self Expandable Metal Stent

    OpenAIRE

    Wagh, Mihir S.; Disaya Chavalitdhamrong; Koorosh Moezardalan; Chauhan, Shailendra S.; Gupte, Anand R.; Michael J. Nosler; Forsmark, Chris E.; Draganov, Peter V.

    2013-01-01

    Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Methods. All consecutive patients with benign biliary strictures were treated with placement of a fully covered SEMS (WallFlex) for 6 mon...

  3. Role of Fully Covered Self-Expandable Metal Stent for Treatment of Benign Biliary Strictures and Bile Leaks

    Energy Technology Data Exchange (ETDEWEB)

    Pausawasadi, Nonthalee [Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok (Thailand); Soontornmanokul, Tanassanee; Rerknimitr, Rungsun [Department of Medicine, Chulalongkorn University, Bangkok (Thailand)

    2012-02-15

    Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant biliary strictures given the long duration of stent patency owing to their larger stent diameter. Recently, SEMS has been used in a variety of benign biliary strictures and leaks, especially with the design of the covered self-expandable metal stent (CSEMS), which permits endoscopic-mediated stent removal. The use of CSEMS in benign biliary stricture could potentially result in a decrease in endoscopic sessions and it is technically easier when compared to placement of multiple plastic stents. However, complications such as cholecystitis due to blockage of cystic duct, stent migration, infection and pancreatitis have been reported. The potential subsegmental occlusion of contralateral intrahepatic ducts also limits the use of CSEMS in hilar stricture. Certain techniques and improvement of stent design may overcome these challenges in the future. Thus, CSEMS may be appropriate in only highly selected conditions, such as refractory benign biliary stricture, despite multiple plastic stent placement or difficult to treat bile duct stricture from chronic pancreatitis, and should not be used routinely. This review focuses on the use of fully covered self-expandable metal stent for benign biliary strictures and bile leaks.

  4. Role of Fully Covered Self-Expandable Metal Stent for Treatment of Benign Biliary Strictures and Bile Leaks

    International Nuclear Information System (INIS)

    Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant biliary strictures given the long duration of stent patency owing to their larger stent diameter. Recently, SEMS has been used in a variety of benign biliary strictures and leaks, especially with the design of the covered self-expandable metal stent (CSEMS), which permits endoscopic-mediated stent removal. The use of CSEMS in benign biliary stricture could potentially result in a decrease in endoscopic sessions and it is technically easier when compared to placement of multiple plastic stents. However, complications such as cholecystitis due to blockage of cystic duct, stent migration, infection and pancreatitis have been reported. The potential subsegmental occlusion of contralateral intrahepatic ducts also limits the use of CSEMS in hilar stricture. Certain techniques and improvement of stent design may overcome these challenges in the future. Thus, CSEMS may be appropriate in only highly selected conditions, such as refractory benign biliary stricture, despite multiple plastic stent placement or difficult to treat bile duct stricture from chronic pancreatitis, and should not be used routinely. This review focuses on the use of fully covered self-expandable metal stent for benign biliary strictures and bile leaks.

  5. Silver-nanoparticle-coated biliary stent inhibits bacterial adhesion in bacterial cholangitis in swine

    Institute of Scientific and Technical Information of China (English)

    Wei Wen; Li-Mei Ma; Wei He; Xiao-Wei Tang; Yin Zhang; Xiang Wang; Li Liu; Zhi-Ning Fan

    2016-01-01

    BACKGROUND: One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over-growth of bacteria. This study aimed to evaluate the feasibility of a novel silver-nanoparticle-coated polyurethane (Ag/PU) stent in bacterial cholangitis model in swine. METHODS: Ag/PU was designed by coating silver nanopar-ticles on polyurethane (PU) stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran-domly divided into an Ag/PU stent group (n=12) and a PU stent group (n=12), respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell (WBC) count, alanine aminotransferase (ALT), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili-ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS: The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS: PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.

  6. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction

    OpenAIRE

    Petersen, Bret T.; Michel Kahaleh; Kozarek, Richard A; David Loren; Kapil Gupta; Thomas Kowalski; Martin Freeman; Chen, Yang K.; Branch, Malcolm S; Steven Edmundowicz; Michael Gluck; Kenneth Binmoeller; Baron, Todd H; Raj J. Shah; Timothy Kinney

    2013-01-01

    Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent...

  7. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).

    OpenAIRE

    Canena, J; Liberato, M; Meireles, L.; Marques, I, e outros; Romão, C.; Coutinho, AP; Neves, BC; Veiga, PM

    2015-01-01

    BACKGROUND: Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear. OBJECTIVE: To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic ste...

  8. Role of stents and laser therapy in biliary strictures

    Science.gov (United States)

    Chennupati, Raja S.; Trowers, Eugene A.

    2001-05-01

    The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), hilar biliary cancer (19% including metastatic disease), nonhilar biliary cancer (14%) and papillary cancer (10%). Endoscopic stenting has widely replaced palliative surgery for malignant biliary obstruction because of its lower risk and cost. Self-expandable metal stents are the preferred mode of palliation for hilar malignancies. Plastic stents have a major role in benign biliary strictures. Major complications and disadvantages associated with metallic stents include high cost, cholangitis. malposition, migration, unextractability, and breakage of the stents, pancreatitis and stent dysfunction. Dysfunction due to tumor ingrowth can be relieved by thermal methods (argon plasma coagulator therapy). We present a concise review of the efficacy of metallic stents for palliation of malignant strictures.

  9. Laparoscopic common bile duct exploration and antegrade biliary stenting: Leaving behind the Kehr tube

    Directory of Open Access Journals (Sweden)

    Darío Martínez-Baena

    2013-03-01

    Full Text Available Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE. Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days than in the Kehr group (12 ± 10.6 days, with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 % and to grade C complications in the Kehr group (6.4 vs. 3.6 %. There were 3 cases of residual common bile duct stones in the Kehr group (6.4 % and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

  10. Management of complications during percutaneous implementation of biliary stents

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods: Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato-renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results: Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato-renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion: Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications

  11. 恶性梗阻性黄疸行内镜下金属胆管支架置入术的护理%Nursing for Endoscopic Metal Biliary Stent Placement of Patients with Malignant Obstructive Jaundice

    Institute of Scientific and Technical Information of China (English)

    杨红玉; 钟珠; 古娜玉; 谢莉娟

    2016-01-01

    Objective To discuss the nursing methods of endoscopic metal biliary stent placement for patients with malignant obstructive jaundice. Methods 120 patients with malignant obstructive jaundice who received endoscopic metal biliary stent placement were randomly divided into two groups equally. The control group received routine nursing, while the observation group received comprehensive nursing intervention. The improvements of clinical symptoms and quality of life, and the incidence of complications were observed and compared between two groups. Results After nursing, the scores of symptoms of observation group were significantly lower than those of control group, and the scores of quality of life were significantly higher than those of control group (all P <0.05). The incidences of complications after surgery of observation group were significantly lower than those of control group (P<0.05). Conclusions Comprehensive nursing intervention for patients with malignant obstructive jaundice treated with endoscopic metal biliary stent placement can effectively relieve patients' clinical symptoms, reduce the incidence of postoperative complications, and improve patients' quality of life.%目的 探讨恶性梗阻性黄疸行内镜下金属胆管支架置入术的护理方法. 方法 将120例行内镜下金属胆管支架置入术的恶性梗阻性黄疸患者随机分为两组 (各60例), 对照组患者实施常规护理, 观察组患者实施综合性护理干预. 观察两组患者的临床症状、 生活质量改善情况及并发症发生率. 结果 观察组护理后的各项症状评分均显著低于对照组, 各项生活质量评分及总评分均显著高于对照组, 术后的高淀粉酶血症、 急性胰腺炎、 胆管感染、 胆管出血、 穿孔、 疼痛的发生率均显著低于对照组, P<0.05. 结论 对行内镜下金属胆管支架置入术的恶性梗阻性黄疸患者实施综合性护理干预, 能有效减轻患者的临床症状,

  12. Treatment of malignant and benign biliary obstructions with metal stents

    International Nuclear Information System (INIS)

    The palliative treatment of malignant bilary tract obstructions using a metal stent is now an established procedure in clinical practice. An endoscopic, transpapillary approach is the first choice for implantation of the stent. If it is not possible to insert the stent in this way, which is often the case with high obstructions, a percutaneous approach is chosen. It appears to be beneficial to use a metal stent with a finemeshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plastic stents so that the primary choice of a metal stent is justified. Coated stents have not yet shown any major advantages. In cases of stent occlusion the coaxial implantation of a plastic stent seems to be the most efficient. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities and exploitation of balloon dilatation and long-term splinting methods. (orig.)

  13. 内镜下同期放置双侧金属胆道支架治疗肝门部胆管恶性梗阻疗效观察%Efficacy of Endoscopic Bilateral Biliary Metal Stent Placement for Malignant Hilar Biliary Obstruction

    Institute of Scientific and Technical Information of China (English)

    高道键; 胡冰; 潘亚敏; 王田田; 王书智; 陆蕊; 王淑萍; 黄慧; 时之梅

    2011-01-01

    Objective To evaluate the safety and efficacy of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents in malignant hilar biliary obstruction. Method From May 2007 to December 2010, a total of 24 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ underwent endoscopic retrograde cholangiopancreatography (ERCP) and bilateral metal stent placement. Technical success rate, functional success rate,ERCP related complications, stents' patency time, and patient' survival time were recorded and reviewed. Results Twenty-one of 24 patients were followed-up for average 39 months. Technical success rate was 100 %, the average operation time was (36.2± 13.9) min, the functional success rate was 95.45%. Mild cholangitis occurred in 2 cases and there was no ERCP related pancreatitis, bleeding, perforation, and death. Stents dysfunction occurred in 7 within follow-up period. Amonge them, plastic stents were inserted through the metallic stents in 4 cases, PTCD was required in 1 case, and conservative therapy was given in the other 2 cases. The median stent' patency time and median patient' survival time were 253 d (95% CI: 199.79-306. 21) and 229 (95% CI : 154.53-303.47),respectively, with no significant differences between Bismuth classification types. Conclusion Endoscopic simultaneous bilateral biliary metal stent placement is technically feasible, safe, and effective to malignant hilar obstruction.%目的 探讨经内镜同期置入双侧可膨式金属胆道支架治疗肝门部胆管恶性梗阻的安全性与有效性.方法 收集2007年5月至2010年12月期间因肝门部胆管恶性梗阻而接受内镜下同期双侧金属支架置入患者,记录技术成功率、引流有效率、随访ERCP相关性并发症、支架通畅期与生存期.结果 共有24例肝门部胆管恶性梗阻患者接受内镜下同期双侧金属支架置入,完成随访21例,平均随访时间39个月.技术成功率为100%,平均耗时(36.2±13

  14. Late Migration of Two Covered Biliary Stents Through a Spontaneous Bilioenteric Fistula in a Patient with Malignant Biliary Obstruction

    International Nuclear Information System (INIS)

    We report a case of simultaneous late migration of two ePTFE-FEP covered biliary endoprostheses (Viabil, W.L. Gore, Flagstaff, AZ, USA) that were percutaneously implanted for the treatment of malignant obstructive jaundice. The first Viabil covered stent was placed successfully without any evidence of dislocation or other complication during follow-up. Occlusion of the stent occurred 4 months later and was treated with the placement of a second stent of the same type. Thirteen months later the patient became symptomatic. Percutaneous transhepatic cholangiography (PTC) revealed the presence of a choledocho-duodenal fistula and the disappearance of the two endoprostheses previously implanted. A third metallic stent was then percutaneously positioned through the bilioenteric fistula. The computed tomography scan that followed for the detection of the metallic bodies did not reveal the dislocated metallic stents. Stent migration is a well-known complication of uncovered metallic stents, though Viabil stent migration is assumed to be most unlikely to happen due to the stent's anchoring barbs. Furthermore, the stent had already been tightly fixed by tumor over- and ingrowth, as recognized in previous imaging. This is a very unusual case, describing the disappearance of two metallic foreign bodies encapsulated by tumor

  15. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.

    Science.gov (United States)

    Dumonceau, J-M; Tringali, A; Blero, D; Devière, J; Laugiers, R; Heresbach, D; Costamagna, G

    2012-03-01

    This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage.

  16. Long-term results of percutaneous self-expandable metallic stents in malignant biliary obstruction

    International Nuclear Information System (INIS)

    Evaluation of the long-term follow-up data of 155 patients with inoperable malignant biliary obstruction who received percutaneous placement of self expandable metallic stent (EMS) and external beam radiotherapy (EBR) combined with self-expandable metallic stent. One-hundred sixty EMS were inserted in 155 patients with inoperable malignant biliary obstruction. One-hundred forty-three patients (Group A) were inserted EMS alone. Twelve patients (Group B) underwent external radiotherapy (40∼45 Gy) after stent insertion. We compared to the Group A and Group B about survival, stent patency and administration. The mean length of survival for the entire group was 111±87 days, while the mean period of patency for all stents was 103±74. We found no statistically significant difference in patient survival or stent patency periods in regard to the level and cause of obstruction. Prolongation of actuarial survival was observed in Group B (316±231 days) as compared to Group A (126±85 days,). Mean length of survival rate and mean period of stent patency rate were not significantly different in regard to the level, cause of obstruction and each stent. External radiotherapy combined EMS could achieve effective palliation and improve the quality of life in selected patients with malignant biliary obstruction. (author)

  17. 内镜下同期放置双侧金属胆道支架的方法探讨%Simultaneous endoscopic bilateral placement of biliary metal stent: a pilot study of 9 cases

    Institute of Scientific and Technical Information of China (English)

    胡冰; 周玉保; 陆蕊; 徐福宁; 李玉茜; 王书智; 时之梅; 黄慧; 王淑萍; 潘亚敏

    2009-01-01

    Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.%目的 探讨经内镜同期置入双侧可膨式金属胆道支架的方法.方法 9例Ⅱ~Ⅳ型肝门部胆管恶性梗阻患者,平均血胆红素(162.8±193.8)μmol/L,内镜下插入双导丝分别留置在左、右侧胆管内,在充分扩张狭窄段后,逐一插入金属支架至双侧肝管予以释放.观察操作的便利性、成功率、控制黄疸有效性、早期并发症和近期的临床疗效.结果 全组均一次成功置入双侧支架,分别采用"Y"型支架置入法2例、塑料支架过渡法1例和并行支架法6例,平均耗时(38.1±14.8)min,以并行法置入且留置支架

  18. The proliferous rule of bile duct endothelium after the placement of metallic biliary stent: a study in canine%犬胆管金属支架诱导胆管内皮的增殖规律

    Institute of Scientific and Technical Information of China (English)

    毛晓楠; 卢再鸣; 郭启勇; 温锋; 梁宏元; 刘兆玉

    2010-01-01

    目的 探讨胆管金属支架植入后胆管内皮随时间的增殖规律.方法 采用经皮经肝穿刺胆囊的途径于犬胆总管下段植入支架,随机分配入1、3、12、24个月4个时间组,分别取支架上段及支架覆盖段胆管组织,通过免疫组化方法检测各组胆管内皮PCNA和Ki-67的表达情况,并通过HE染色测量支架覆盖段胆管壁厚度,比较不同位置胆管内皮增殖水平的差异,比较相邻时间组支架覆盖段胆管内皮增殖活性及胆管壁厚度的差异,采用两随机样本t检验进行统计学分析.结果 共18只实验犬建模成功.免疫组化及病理结果显示各时间组支架覆盖段胆管内皮的增殖活性明显高于支架上段(P<0.05);支架覆盖段胆管内皮的增殖活性及胆管壁厚度在支架植入后1个月内明显增高(P<0.05),之后经过一个相对的增殖平衡期,在支架植入后3~12个月期间再次逐渐增高并维持高增殖状态(P<0.05).结论 胆管金属支架能够诱导胆管内皮增殖,这种增殖活性在支架植入后3~12个月之间逐渐显现并加强,并在支架植入12个月以后继续维持.%Objective To discuss the proliferous rule of bile duct endothelium after the placement of metallic biliary stent. Methods The metallic biliary stent was placed at the inferior segment of common bile duct of canine after a percutaneous transhepatic puncture at cholecyst. All the stented dogs were assigned randomly to 4 group including A、B、C and D, each group had been under research for 1 month, 3 months, 12 months and 24 months. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were calculated on the immunohistochemistry staining images and compared with those uncovered in each group, then the expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were compared between every two adjacent groups. The thickness of bile duct wall covered by the stent were measured on the HE

  19. Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young-Min; Kwak, Hyo-Sung; Jin, Gong-Yong; Lee, Seung-Ok; Chung, Gyung-Ho [Chonbuk National University Medical School and Hospital, Chonju (Korea, Republic of)

    2007-10-15

    We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50 80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2 81 weeks). Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

  20. Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Seok [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Shin, Tae Beom [Dept. of Diagnostic Radiology, Kimhae Jung Ang Hospital, Kimhae (Korea, Republic of); Hwang, Jae Cheol [Dept. of Radiology, Ulsan Hospital, Ulsan (Korea, Republic of); Bae, Jae Ik [Dept. of Radiology, Ajou University Hospital, Suwon (Korea, Republic of); Kim, Chang Won [Dept. of Radiology, Busan National University Hospital, Busan (Korea, Republic of)

    2012-01-15

    To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

  1. Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

  2. Use of the Viabil Covered Stent in the Treatment of a Benign Biliary Stricture with the Subsequent Development of Acute Pancreatitis

    OpenAIRE

    Burke, Charles T.; Stavas, Joseph M.

    2007-01-01

    The use of bare metal stents for benign biliary strictures is typically avoided due to historically poor long-term patency. Thus, in patients who are not surgical candidates, the management of benign biliary strictures can be a frustrating process. This article describes a patient who developed a common bile duct stricture following a complex endovascular thoracoabdominal aneurysm repair. The stricture was treated with the placement of a covered metallic biliary stent; a procedure complicated...

  3. Endoscopic removal of a spontaneously fractured biliary uncovered self-expandable metal stent.

    Science.gov (United States)

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Tsujino, Takeshi; Nakai, Yousuke; Sasahira, Naoki; Kogure, Hirofumi; Hamada, Tsuyoshi; Nagano, Rie; Miyabayashi, Kouji; Yamamoto, Keisuke; Mohri, Dai; Sasaki, Takashi; Ito, Yukiko; Yamamoto, Natsuyo; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2012-05-01

    Self-expandable metal stents (SEMS) are widely used for the palliative treatment of unresectable malignant biliary obstruction. However, the long-term durability of SEMSs in biliary strictures is not clear. We describe a case of endoscopic removal of spontaneously fractured uncovered biliary SEMS. A 59-year-old woman presented to our institution with a 1-year history of recurrent cholangitis. Her medical history included a proctectomy for rectal cancer and right hemihepatectomy for liver metastasis 10 years earlier. Five years after these operations, she developed a benign hilar stricture and had an uncovered SEMS placed in another hospital. Endoscopic retrograde cholangiopancreatography demonstrated that the SEMS was torn in half and the distal part of the stent was floating in the dilated common bile duct. The papillary orifice was dilated by endoscopic papillary large balloon dilation (EPLBD) using a 15-mm wire-guided balloon catheter. Subsequently, we inserted biopsy forceps into the bile duct and grasped the distal end of the broken SEMS under fluoroscopy. We successfully removed the fragment of the SEMS from the bile duct, along with the endoscope. The patient was discharged without complications. Placement of an uncovered biliary SEMS is not the preferred treatment for benign biliary strictures. Spontaneous fracture of an uncovered biliary SEMS is an extremely rare complication. We should be aware that stent fracture can occur when placing uncovered biliary SEMSs in patients with a long life expectancy. EPLBD is very useful for retrieving the fractured fragment of SEMS. PMID:22507093

  4. Self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent for the palliative treatment of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Oong; Jung, Gyoo Sik; Han, Byung Hoon; Shin, Dong Hoon [Gospel Hospital, College of Medicine, Kosin University, Busan (Korea, Republic of); Ko, Ji Ho [Masan Samsung Medical Center, Sungkyunkwan University School of Medicine, Masan (Korea, Republic of)

    2008-06-15

    We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S and G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice occurred in six cases; stent migration occurred in four cases and tumor overgrowth occurred in two cases. The survival rates were 97%, 80%, 67% and 59% at 1, 3, 6 and 9 months, respectively. The stent patency rates were 96%, 92%, 86% and 86% at 1, 3, 6 and 9 months, respectively. Self-expandable PTFE-covered nitinol stent placement seems to be technically feasible and effective for the palliative treatment of malignant biliary obstruction.

  5. Placement of biliary self-expandable metal stents after metal stenting in duodenum%十二指肠恶性狭窄金属支架置入术后再次金属支架置入的影响因素研究

    Institute of Scientific and Technical Information of China (English)

    张利; 张荣春; 罗辉; 潘阳林; 郭学刚

    2015-01-01

    目的:探讨Ⅰ型及Ⅱ型十二指肠恶性狭窄患者金属支架置入术后,再行 ERCP 置入胆道金属支架成功与否的影响因素。方法纳入2010年2月至2014年2月间无法手术切除的十二指肠Ⅰ型或Ⅱ型狭窄患者36例,行内镜金属支架植入术后因胆道恶性狭窄需行 ERCP 胆道金属支架植入,分析其临床及影像学资料并进行多因素回归分析。结果患者行 ERCP 胆道金属支架植入术总成功率为66.7%,Ⅰ型和Ⅱ型狭窄者的 ERCP 成功率分别为88.0%和18.2%(P <0.001)。十二指肠狭窄长度<3.5 cm 和≥3.5 cm ERCP 成功率分别为88.9%和44.4%(P =0.005)。与植入80或90 mm肠道支架相比,植入60 mm 肠道支架后 ERCP 成功率较高(88.0%比18.2%,P <0.001)。多因素回归分析显示十二指肠狭窄长度≥3.5 cm[OR =9.85,95%CI(1.21~79.88)]和80或 90 mm 肠道支架长度[OR =17.03,95%CI(1.99~145.81)]为 ERCP 失败的独立因素。结论已植入十二指肠金属支架患者行 ERCP 胆道金属支架置入术是安全有效的。十二指肠狭窄段较长及肠道支架较长是影响 ERCP 成功的危险因素。%Objective To explore the success rate and failure risk factors of biliary stenting on the patients with type Ⅰor Ⅱ duodenal malignant stricture treated by self-expandable metallic stent (SEMS). Methods A total of 36 patients with unresectable duodenal stricture after endoscopic SEMS placement be-tween February 2010 and February 2014 at Xijing Digestive Disease Hospital were enrolled.These patients underwent ERCP biliary metal stenting subsequently due to the malignant biliary stenosis.The clinical and imaging features of these patients were retrospectively analyzed.Results ERCP biliary stenting was suc-cessfully completed in 66.7% of patients with previous duodenal SEMS treatment.The success rates of pa-tients with type Ⅰ and

  6. Fracture of Memotherm Metallic Stents in the Biliary Tract

    International Nuclear Information System (INIS)

    In a series of 66 patients who had palliation of malignant obstructive jaundice by percutaneous placement of Memotherm expanding metal stents, we report four cases of stent fracture. This has not been reported previously

  7. Drug eluting biliary stents to decrease stent failure rates: Areview of the literature

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Biliary stenting is clinically effective in relieving bothmalignant and non-malignant obstructions. However, thereare high failure rates associated with tumor ingrowth andepithelial overgrowth as well as internally from biofilmdevelopment and subsequent clogging. Within the lastdecade, the use of prophylactic drug eluting stents as ameans to reduce stent failure has been investigated. Inthis review we provide an overview of the current researchon drug eluting biliary stents. While there is limited humantrial data regarding the clinical benefit of drug elutingbiliary stents in preventing stent obstruction, recentresearch suggests promise regarding their safety andpotential efficacy.

  8. Removal of an embedded "covered" biliary stent by the "stent-in-stent" technique

    OpenAIRE

    Menon, Shyam

    2013-01-01

    A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction. A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography (ERCP) and cytology was benign. A 6 cm fully covered self-expanding metal stent (SEMS) was inserted across the stricture to optimize biliary drainage. However, the SEMS could not be removed at repeat ERCP a few months later. A further fully covered SEMS...

  9. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  10. Percutaneous therapy of inoperable biliary stenoses and occlusions with a new self-expanding nitinol stent (SMART)

    International Nuclear Information System (INIS)

    Objective: To evaluate the treatment of malignant biliary stenoses and occlusions using a new stent. Methods: In a prospective study, 25 patients with malignant obstructive jaundice were treated with SMART stents. The handling and the quality of stent expansion were documented. Stent function was assessed 2-4 days after intervention by cholangiography and laboratory tests. A follow-up was performed three months, after stent placement. Results: All lesions were treated successfully, with a total of 35 stents implanted. In 14 patients a further balloon dilatation was performed after stent placement (8-10 mm diameter/40-80 mm length). The mean serum bilirubin level decreased significantly from 11.6 mg/dl to 4.6 mg/dl after intervention (p<0.05). The follow-up showed a mean serum bilirubin level at 4.0 mg/dl. In 4 cases (16%) a further intervention (PTCD or stent) was performed. Six patients died due to tumor progression. The stents proved to be patent in 79% (n=15) of patients alive at the time of follow-up. Conclusions: Placement of the SMART stent for the therapy of malignant biliary lesions yields good technical and clinical results. (orig.)

  11. Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients

    OpenAIRE

    Hsieh, Jennifer; Thosani, Amar; Grunwald, Matthew; Nagula, Satish; Bucobo, Juan Carlos; Jonathan M Buscaglia

    2015-01-01

    Controversy exists over the need for unilateral versus bilateral stent placement in patients with malignant obstruction at the biliary hilum. Placement of bilateral uncovered self-expanding metal stent (UCSEMS) at this location is technically challenging, and generally associated with lower rates of procedural success. Serial insertion of side-by-side UCSEMS may be especially difficult when simultaneous deployment is not possible using larger stent delivery catheters. In this single-center, r...

  12. Post-biliary sphincterotomy bleeding despite covered metallic stent deployment

    Science.gov (United States)

    Donatelli, Gianfranco; Cereatti, Fabrizio; Dumont, Jean-Loup; Dhumane, Parag; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno

    2016-01-01

    Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist. PMID:27489716

  13. A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Esther; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang [Dept. of Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

    2013-04-15

    To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency. 41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis. After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742). In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

  14. A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

    International Nuclear Information System (INIS)

    To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency. 41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis. After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742). In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

  15. Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors

    OpenAIRE

    Jang, Sung Ill; Lee, Dong Ki

    2015-01-01

    Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-e...

  16. Trimming a Metallic Biliary Stent Using an Argon Plasma Coagulator

    International Nuclear Information System (INIS)

    Background. Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. Methods. Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. Observations. The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. Conclusions. In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration

  17. Coronary stent placement via radial artery for the treatment of circuitous hepatic artery stenosis after orthotopic liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility and effectiveness of coronary stent placement via radial artery in the treatment of circuitous hepatic artery stenosis after orthotopic liver transplantation. Methods: Six patients with circuitous hepatic artery stenosis after orthotopic liver transplantation, encountered during the period of June 2006-Apr. 2008, were enrolled in this study. The stenosis occurred in 6-110 days (mean 47 days) after orthotopic liver transplantation. Stent placement through the left radial artery was carried out in 2 patients after the catheterization via the right femoral artery failed. Based on the preoperative CTA findings, stent placement through left radial artery was straightly performed in 4 patients. Thrombolytic therapy with 500,000 unit of urokinase was adopted in one patient with hepatic thrombus before stent placement. Percutaneous transhepatic biliary drainage (PTCD) was simultaneously performed with stent placement in two patients with dilated biliary tract. Results: The technical success rate was 100%. Thrombolytic therapy was successful in one patient with hepatic thrombus and PTCD had a curative effect on the biliary tract dilatation in two patients. During a follow-up period of 36-148 days (median 76 days), no stent stenosis was found on color Doppler ultrasonogram, the hepatic arteries remained patent in all patients. The hepatic functional parameters were improved in all cases. Conclusion: Coronary stent placement via radial artery is an effective treatment for circuitous hepatic artery stenosis after orthotopic liver transplantation. (authors)

  18. 改良经皮肝穿刺胆道引流术及经皮胆道支架置入治疗恶性梗阻性黄疸%Management of malignant obstructive jaundice by Improved PTCD and percutaneous biliary tract stents placement

    Institute of Scientific and Technical Information of China (English)

    刘会春; 李宗狂; 周磊; 鲁贻民; 周少波

    2008-01-01

    Objective To investigate the clinical value of improved percutaneous tramhepatic cholangiographic drainage(PTCD)and percutaneous placement of biliary metallic stents on the treatment of malignant obstructive jaundice.Methods Thirty three patients with malignant biliary obstruction were treated by the improved PTCD guided by ultrasound followed by pereutaneous placement of biliary tract metallic stcnts 1~3 weeks later.Results Improved PTCD WaS succeeded in all the patients,30 patients(90.9%)accepted percutaneous placement of biliary metallic stents successfully,3 patients who failed in stents placement accepted PTCD again for palliative management of iallndice.Thofle who failed in stent placement were found to have bleeding from the PTCD tube,but recovered several days later.Jaundice alleviated in all the patients.The patients were followed up for 1~29 months,medium follow-up period is 14.8 months.Six cases were found lever and jaundice,among that,two ageepted improved PTCD again,one recovered after antibioic treatment,the remaining 3 patients failed in further treatment due to the metastasis of the tumor.Condusion Pereutaneous placement of biliary metallic stents after improved PTCD is a safe and effeetive method to relieve malignant biliary obstruction,it can improve life quality,prolong survival time.This method could be a good choice for treating the patients with mnlignant biliary obstruction without operation.%目的 探讨改良经皮肝穿刺胆道引流术(PTCD)及经皮胆道支架置入在恶性梗阻性黄疸中的治疗价值.方法 33例恶性胆道梗阻患者,采用改良PTCD,并在当时或1~3周后行经皮胆道可膨式金属支架置入.结果 改良PTCD成功率100%,支架置入成功率90.9%(30/33).随访1~29个月,中位生存14.8个月.6例随访期间出现发热、黄疸,其中1例重置PTCD后症状缓解,1例抗炎、利胆治疗后症状消失,1例重置PTCD管后黄疸短暂消失,渐出现混合性黄疸,另3例因肿瘤广

  19. A study of impact of stent implantation in distal common bile duct on duodenal-biliary reflux

    International Nuclear Information System (INIS)

    Objective: This study aimed to investigate the incidence and the cause for duodenal- biliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct. Methods: After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct. Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilimbin and direct bilirubin in blood were performed for all patients. Two to five days [an average of (3.3±0.9) days] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P9/L, and the median of neutrophil percentage was 0.74. Compared with those before stent implantation, the difference did not reach statistical significance (t=0.423, Z=1.036, P>0.05). After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92.2 and 74.3 μmol/L. Compared with those before stenting, the difference was statistically significant (Z=-3.170, -3.170, P<0.05). Conclusions: There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux. (authors)

  20. Endoscopic placement of pancreatic stents and drains in the management of pancreatitis.

    Science.gov (United States)

    Kozarek, R A; Patterson, D J; Ball, T J; Traverso, L W

    1989-01-01

    Although widely used in the biliary tree, little data is available on endoscopic placement of stents or drains within the pancreas. This report describes 17 patients, nine with acute relapsing pancreatitis and eight with chronic pancreatitis, who had drain or stent placement for hypertensive pancreatic duct (PD) sphincter, dominant ductal stenosis, duct disruption, or pseudocyst. Two patients have subsequently undergone surgery, and six other patients continue long-term stent placement with marked reduction of chronic pain or attacks of recurrent pancreatitis. All six pseudocysts resolved, although one recurred and required surgery. It is concluded that pancreatic drains or stents may obviate the need for surgery, temporize before definitive therapy, or direct a subsequent surgical procedure. Images Figs. 1A and B. Figs. 2A-C. Figs. 2A-C. Fig. 3. Figs. 4A-D. Figs. 5A and B. PMID:2923512

  1. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    International Nuclear Information System (INIS)

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  2. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  3. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction

    Directory of Open Access Journals (Sweden)

    Bret T. Petersen

    2013-01-01

    Full Text Available Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1 absence of stent occlusion within six months or until death, whichever occurred first and (2 technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58, with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55 of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

  4. The clinical application of domestic biliary metallic stents

    International Nuclear Information System (INIS)

    Objective: To determine the clinical efficacy and safety of domestic biliary metallic stents in the management of biliary obstruction. Methods: 75 domestic biliary metallic stents were implanted in 66 of 72 patients with obstructive jaundice due to malignant (n=70) and benign stenoses (n=2). Results: The technical successful rate was 92.7% (64/66). Palliation with rid of jaundice was achieved in 96.9% (64/66) within 1 month. The 30-day mortality rate was 3% (2/66). Early complications occurred in 7.6% (5/66). 44 patients were followed from 2 to 24 months after treatment. 33 (33/42) of 42 patients with malignancy died after a median survival of 5.3 months (range 2-23 months). The remaining 9 patients (9/42) remained alive with a mean follow-up of 11.6 months. The stent patency rates were 92.8%, 89.9% and 79.4 % at 3, 6, 12 months respectively. 6 patients (6/42) presented stent occlusion within a median period of 3 months. One of two patients with benign stenoses sustained a patency duration time of 24 months. One patient died 3 months after treatment. Conclusions: The domestic biliary metallic stent implantation is efficacy and safety in the management of biliary obstruction. (authors)

  5. Effectiveness and Safety of Endoscopic Treatment of Benign Biliary Strictures Using a New Fully Covered Self Expandable Metal Stent

    Directory of Open Access Journals (Sweden)

    Mihir S. Wagh

    2013-01-01

    Full Text Available Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures. Methods. All consecutive patients with benign biliary strictures were treated with placement of a fully covered SEMS (WallFlex for 6 months. Short- and long-term stricture resolution, adverse events, and ease of stent removal were recorded. Results. 23 patients were enrolled. Stricture etiology was chronic pancreatitis (14, postorthotopic liver transplant (4, idiopathic (4, and biliary stones (1. All ERCPs were technically successful. All stents were successfully removed. Short-term stricture resolution was seen in 22/23 (96% patients. Long-term success was 15/18 (83.3%. All 3 failures were patients with biliary strictures in the setting of chronic calcific pancreatitis. Conclusions. The use of the new SEMS for the treatment of benign biliary strictures led to short-term stricture resolution in the vast majority of patients. Over a long-term followup the success rate appears favorable compared to historical results achieved with multiple plastic stenting, particularly in patients with chronic pancreatitis. The study was registered with ClinicalTrials.gov (NCT01238900.

  6. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients

    Directory of Open Access Journals (Sweden)

    Liberato Manuel José

    2012-08-01

    Full Text Available Abstract Background Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS and plastic stents (PS.We also compared unilateral and bilateral stent placement according to the Bismuth classification. Methods Data on 480 patients receiving endoscopic biliary drainage for hilar cholangiocarcinoma between September 1995 and December 2010 were retrospectively reviewed to evaluate the following outcome parameters: technical success (TS, functional success (FS, early and late complications, stent patency and survival. Patients were followed from stent insertion until death or stent occlusion. Patients were divided into 3 groups according to the Bismuth classification (Group 1, type I; Group 2, type II; Group 3, type > III. Results The initial stent insertion was successful in 450 (93.8% patients. TS was achieved in 204 (88.3% patients treated with PS and in 246 (98.8% patients palliated with SEMS (p P P  Conclusions SEMS insertion for the palliation of hilar cholangiocarcinoma offers higher technical and clinical success rates in the ITT analysis as well as lower complication rates and a superior cumulative stent patency when compared with PS placement in all Bismuth classifications. The cumulative patency of bilateral SEMS or PS stents was significantly higher than that of unilateral SEMS or PS stents, with lower occlusion rates in Bismuth II patients.

  7. Biliary Leak in Post-Liver-Transplant Patients: Is There Any Place for Metal Stent?

    Directory of Open Access Journals (Sweden)

    Fernanda P. Martins

    2012-01-01

    Full Text Available Objectives. Endoscopic management of bile leak after orthotopic liver transplant (OLT is widely accepted. Preliminary studies demonstrated encouraging results for covered self-expandable metal stents (CSEMS in complex bile leaks. Methods. Thirty-one patients with post-OLT bile leaks underwent endoscopic temporary placement of CSEMS (3 partially CSEMS , 18 fully CSEMS with fins and 10 fully CSEMS with flare ends between December 2003 and December 2010. Long-term clinical success and safety were evaluated. Results. Median stent indwelling and follow-up were 89 and 1,353 days for PCSEMS, 102 and 849 for FCSEMS with fins and 98 and 203 for FCSEMS with flare ends. Clinical success was achieved in 100%, 77.8%, and 70%, respectively. Postplacement complications: cholangitis (1 and proximal migration (1, both in the FCSEMS with fins. Postremoval complications were biliary strictures requiring drainage: PCSEMS (1, FCSEMS with fins (6 and with flare ends (1. There was no significant differences in the FCSEMS groups regarding clinical success, age, gender, leak location, previous treatment, stent indwelling, and complications. Conclusion. Temporary placement of CSEMS is effective to treat post-OLT biliary leaks. However, a high number of post removal biliary strictures occurred especially in the FCSEMS with fins. CSEMS cannot be recommended in this patient population.

  8. Endoscopic parallel placement of biliary double metal stents for advanced malignant hilar obstruction%内镜下平行法双金属支架引流治疗晚期肝门部胆管恶性梗阻价值探讨

    Institute of Scientific and Technical Information of China (English)

    王成; 黄强; 邵峰; 胡元国; 邱陆军; 林先盛

    2013-01-01

    目的 探讨经内镜平行法双金属支架引流治疗晚期肝门部胆管恶性梗阻的安全性和疗效.方法 2011年1月至2012年9月对11例晚期肝门部胆管恶性梗阻的病人采用内镜平行法双金属支架引流治疗,观察疗效及安全性.结果 10例成功置入左右双金属支架,全组无研究并发症及死亡病例.9例引流有效.发生2例轻微内镜相关并发症.10例双支架治疗病人中4例死亡,死亡时均无腹痛、黄疸、发热等支架阻塞迹象,生存128 ~ 185 d,失访1例,其余5例病人均在随访中.结论 内镜平行法双金属支架引流治疗晚期肝门部胆管恶性梗阻是安全可行的.%Objective To explore the effects and safety of endoscopic parallel placement of double metal stents on unresectable hilar malignant obstruction.Methods The clinical data of 11 patients with malignant hilar obstructive jaundice due to advanced carcinoma who were treated with parallel placement of double biliary stents from January 2011 to September 2012 were retrospectively analyzed.Results Out of 11 patients,10(90.9%) were successfully embedded with double biliary stents and 4 were dead during the follow-up.There was no sign of stent occlusion during the follow-up period.The survival time ranges from 128 to 185 days.One case was lost during the follow-up and 5 others are still alive.Conclusion The endoscopic parallel placement of double biliary stents is effective and safe for patients with unresectable malignant hilar obstruction.

  9. Predictors for occlusion of the first inserted metallic stent in patients with malignant biliary obstruction

    OpenAIRE

    Wandong Hong; Yunfei Zhu; Yanyan Dong; Yanqing Wu; Mengtao Zhou; Haizhen Ni

    2015-01-01

    Background/Aims: Endoscopic biliary stent drainage plays an important role in the palliative treatment of malignant biliary obstruction. The aim of this study was to investigate predictors of occlusion of first metal inserted stent in patients with malignant biliary obstruction. Patients and Methods: The retrospective analysis was performed in 178 patients with malignant biliary obstruction. Factors associated with stent occlusion were analyzed by Cox regression analysis. Results: Median over...

  10. Intrahepatic artery pseudoaneurysm associated with a metallic biliary stent after living donor liver transplantation: report of a case.

    Science.gov (United States)

    Harada, Noboru; Shirabe, Ken; Soejima, Yuji; Taketomi, Akinobu; Yoshizumi, Tomoharu; Asonuma, Katsuhiro; Inomata, Yukihiro; Maehara, Yoshihiko

    2013-06-01

    An intrahepatic artery pseudoaneurysm (IHAA) is a very rare but potentially lethal complication occurring after liver transplantation. This report presents a case of an IHAA associated with a metallic biliary stent after liver transplantation. A 40-year-old male underwent living donor liver transplantation (LDLT) using a left lobe graft. The bile duct reconstruction was performed with Roux-en-Y hepaticojejunostomy. He developed obstructive jaundice 5 years after LDLT, and had biliary stricture of the anastomosis area, therefore, the two metallic biliary stents were finally positioned at the stricture of the biliary tract. He suddenly developed hematemesis 8 years after LDLT, and computerized tomography scan showed an IHAA. Although seven interlocking detachable coils were placed at the neck of the aneurysm, hematemesis recurred 3 days after the initial embolization. Therefore, retransplantation was successfully performed 25 days after the embolization of IHAA using a right lobe graft from his son. In conclusion, metal stent insertion can lead to the fatal complication of HAA. The placement of a metallic stent could have been avoided in this case. Percutaneous metallic stent insertion for biliary stenosis after liver transplantation should therefore only be performed in carefully selected patients. PMID:22914885

  11. Linear 125I seeds strand implantation combined with biliary stenting for the treatment of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Objective: To evaluate the therapeutic efficacy of linear 125I seeds strand implantation combined with biliary stenting in treating malignant biliary obstruction. Methods: Linear 125I seeds strand implantation combined with biliary stenting was carried out in 28 patients with malignant biliary obstruction. The technical success rate, the clinical efficacy, the postoperative complications and the survival rate were analyzed. Results: Both biliary stenting and 125I seeds strand implantation were successfully accomplished in all patients. No serious complications occurred. After the procedure the biliary obstruction symptoms were markedly improved and the bilirubin level was significantly reduced (P125I seeds strand implantation together with biliary stenting is safe and effective although its long-term efficacy needs to be further studied. (authors)

  12. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study.

    Science.gov (United States)

    Traina, Mario; Tarantino, Ilaria; Barresi, Luca; Volpes, Riccardo; Gruttadauria, Salvatore; Petridis, Ioannis; Gridelli, Bruno

    2009-11-01

    After liver transplantation, the most common biliary complication is the anastomotic stricture, which is followed by biliary leakage. Studies have focused on the endoscopic treatment of biliary complications in transplanted patients with duct-to-duct reconstruction, showing a success rate of 70% to 80% after orthotopic liver transplantation and of 60% after living-related liver transplantation. Once the endoscopic approach fails, surgical treatment with a Roux-en-Y choledochojejunostomy is the sole alternative treatment. The aim of this prospective observational study was to analyze the efficacy and safety of fully covered self-expandable metallic stents for the treatment of posttransplant biliary stenosis and leaks in patients in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) failed. From January 2008 to January 2009, 16 patients met the criteria of endoscopic treatment failure, and instead of surgery, a fully covered stent was placed. All patients had at least 6 months of follow-up (mean follow-up of 10 months). After removal, 14 patients showed immediate resolution of both the biliary stenosis and leak. After a mean of 10 months of follow-up, only 1 patient showed biliary stenosis recurrence. No major complications occurred in any of the patients, except for stent migration in 6 patients, although these presented with no clinical consequences. In conclusion, in patients not responding to standard endoscopic treatment, the placement of fully covered metal stents is a valid alternative to surgery. A cost analysis should be performed in order to evaluate whether to treat transplanted patients suffering from biliary complications with covered self-expandable metallic stent placement as first-line therapy. PMID:19877248

  13. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    OpenAIRE

    Paul J Belletrutti; Hans Gerdes; Schattner, Mark A

    2010-01-01

    Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drai...

  14. Utility of MR cholangiography for follow-up examination after metallic stent placement in the bile duct

    International Nuclear Information System (INIS)

    To evaluate the efficacy of MR cholangiography for follow-up examination after metallic stent placement in the bile duct. Between December 1999 and June 2000, 15 patients with biliary obstruction in whom metallic biliary stents had been placed underwent MR cholangiography during follow-up examination. The causes of obstruction were hilar cholangiocarcinoma (n=6), common bile duct cancer (n=5), gall bladder cancer (n=1) and pancreatic cancer (m=3). The types of self-expandable metallic stent employed were the nitinol stent (n=2), the endocoil nitinol stent (n=3), the ultraflexed diamond stent (n=5), and the wallstent (n=5). Using MR cholangiography, we measured the diameter of that part of the biliary stent which showed high signal intensity, assigning one point if this was less than one third of the stent diameter, two points of between one third and two thirds, and three points if more than two thirds. We decided that a higher score indicated fewer artifacts. The score was 1.7-3 (mean, 2.3) points for the endocoil nitinol stent, 1.7-2.3 (mean, 2) for the nitinol stent, and 1-3 (mean, 1.7) for the ultraflex diamond stent. In most cases, two thirds of the stent diameter was observed. For the wallstent, the score was 1-1.7 (mean, 1.3) points and the inner portion of the stent was almost invisible. MR cholangiography is not useful for follow-up examination after the placement of wallstents and three other types of nitinol stent in the bile duct

  15. Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation

    Institute of Scientific and Technical Information of China (English)

    Tsuyoshi Hamada; Kazuhiko Koike; Yousuke Nakai; Saburo Matsubara; Hiroyuki Isayama; Akiko Narita; Kazuhiro Watanabe; Yukihiro Koike; Shigeo Matsukawa; Tateo Kawase

    2011-01-01

    In endoscopic placement of multiple plastic biliary stents (PBSs), we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion. We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis. Although proximal dislocation of the first PBS was observed, we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire. We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath. It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb. Here we introduce this "anchor-wire technique", which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.

  16. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    Directory of Open Access Journals (Sweden)

    Paul J Belletrutti

    2010-05-01

    Full Text Available Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient’s jaundice and pruritus subsequently resolved. Conclusion This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.

  17. 经皮肝穿刺金属内支架置入治疗胆道恶性阻塞性黄疸的临床疗效%Clinical Effect of Percutaneous Transhepatic Metallic Stent Placement for Malignant Biliary Obstructive Jaundice

    Institute of Scientific and Technical Information of China (English)

    何旭; 顾建平; 楼文胜; 陈亮; 陈国平; 宋进华

    2011-01-01

    目的 探讨经皮肝穿刺金属胆道内支架置入治疗胆道恶性阻塞性黄疸的临床疗效.方法 在X线引导下对26例胆道恶性阻塞性黄疸患者,行经皮肝穿刺胆道金属内支架置入治疗.根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式.结果 26例患者共置入30枚金属支架,其中,20例置人l枚于肝总管和(或)胆总管,4例置入2枚于左右肝管-胆总管内,2例为支架内再狭窄后的重新置入.26例患者术前血清总胆红素(198.83±121.51)μmol/L,直接胆红素(136.74±79.36) μmol/L.术后2周复查,血清总胆红素下降到(93.52±59.60)μmol/L,直接胆红素下降到( 46.33±42.71) μmol/L( P<0.01).出现并发症2例(7.5%).结论 经皮肝穿刺胆道金属内支架置入术是治疗胆道恶性阻塞性黄疸的有效方法.%Objective To evaluate the clinical effect of percutaneous transhepatic metallic stent placement for malignant biliary obstructive jaundice. Methods 26 patients with malignant biliary obstructive jaundice were treated with percutaneous transhepatic metallic stent placement under fluoroscopy guidence, according to the obstructive site and degree. Results 30 metallic stents were placed in 26 patients, single stent was deployed in 20 patients. 2 stents were deployed in the common duct and hepatic branches in 4 patients,2 stents were deployed due to biliary re-stenosis in 2 patients. After 2 weeks, the level of serum total hilirubin decreased markedly from (198.83 ± 121.51) μmol/L to (93.52 ± 59.60) μmol/L, the level of serum direct bilimbin decreased markedly from (136.74 ± 79.36) Hmol/L to (46.33 ±42.71)Hmol/L (P<0.01). Complications were observed in 2 cases(7.5%). Conclusion Percutaneous transhepatic metallic stent placement is an effective therapy for malignant biliary obstructive jaundice.

  18. Effectiveness of percutaneous metal stent placement in cholangiocarcinoma patients with midterm follow-up: Single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Kose, Fatih, E-mail: fatihkose@gmail.com [Baskent University Faculty of Medicine, Department of Medical Oncology, Adana (Turkey); Oguzkurt, Levent [Department of Interventional Radiology, Adana (Turkey); Besen, Ayberk; Sumbul, Taner; Sezer, Ahmet; Karadeniz, Cemile; Disel, Umut; Mertsoylu, Huseyin; Ozyilkan, Ozgur [Baskent University Faculty of Medicine, Department of Medical Oncology, Adana (Turkey)

    2012-08-15

    Purpose: Patients with advanced cholangiocarcinoma present with high rate of local complications. The primary aim of this study is to report clinical course of advanced cholangiocarcinoma patients those who were presented with biliary obstruction and treated with percutaneous biliary stenting. Material and methods: Patients with unresectable locally advanced or metastatic cholangiocarcinoma followed by our center for a period of 4 years were analyzed. For statistical analysis demographic and clinical characteristics of patients, primary biliary drainage method, metal stent occlusion rate, time to stent occlusion, and overall survival rates were recorded. Results: A total of 34 eligible patients were analyzed. 27 patients had metal stent placement. These 27 patients formed the basis of this study. Median overall survival (OS) was 6.0 months. After metal stent deployment bilurubin levels were normalized within a mean of 10 days. During the follow-up period, 13 patients were experienced metal stent occlusion. Median TtSO was 10 weeks. Cytotoxic chemotherapy was administered to 14 (52%) patients. Patients without stent dysfunction had significantly higher rate of chemotherapy exposure rate (p = 0.021). Statistical analysis, however, failed to exhibit significant effect of stent dysfunction on OS. Conclusion: In advanced cholangiocarcinoma, relief of bile duct obstruction is an important part of the initial patient management. This study therefore described the clinical value of percutaneous metal stent in cholangiocarcinoma patients and raises the question about patency of metal stent in cholangiocarcinoma whether we can expect success similar to the success achieved in pancreas carcinoma.

  19. Effectiveness of percutaneous metal stent placement in cholangiocarcinoma patients with midterm follow-up: Single center experience

    International Nuclear Information System (INIS)

    Purpose: Patients with advanced cholangiocarcinoma present with high rate of local complications. The primary aim of this study is to report clinical course of advanced cholangiocarcinoma patients those who were presented with biliary obstruction and treated with percutaneous biliary stenting. Material and methods: Patients with unresectable locally advanced or metastatic cholangiocarcinoma followed by our center for a period of 4 years were analyzed. For statistical analysis demographic and clinical characteristics of patients, primary biliary drainage method, metal stent occlusion rate, time to stent occlusion, and overall survival rates were recorded. Results: A total of 34 eligible patients were analyzed. 27 patients had metal stent placement. These 27 patients formed the basis of this study. Median overall survival (OS) was 6.0 months. After metal stent deployment bilurubin levels were normalized within a mean of 10 days. During the follow-up period, 13 patients were experienced metal stent occlusion. Median TtSO was 10 weeks. Cytotoxic chemotherapy was administered to 14 (52%) patients. Patients without stent dysfunction had significantly higher rate of chemotherapy exposure rate (p = 0.021). Statistical analysis, however, failed to exhibit significant effect of stent dysfunction on OS. Conclusion: In advanced cholangiocarcinoma, relief of bile duct obstruction is an important part of the initial patient management. This study therefore described the clinical value of percutaneous metal stent in cholangiocarcinoma patients and raises the question about patency of metal stent in cholangiocarcinoma whether we can expect success similar to the success achieved in pancreas carcinoma.

  20. Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders

    OpenAIRE

    Lorenz Theilmann; Ahmed Abdel Samie

    2012-01-01

    Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following...

  1. An Update to Hepatobiliary Stents

    OpenAIRE

    Moy, Brian T.; Birk, John W.

    2015-01-01

    Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simpl...

  2. Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

    Institute of Scientific and Technical Information of China (English)

    Won; Jae; Yoon; Ji; Kon; Ryu; Jung; Won; Lee; Dong-Won; Ahn; Yong-Tae; Kim; Yong; Bum; Yoon; Sang; Myung; Woo; Woo; Jin; Lee

    2010-01-01

    AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patient...

  3. Long-term effects of forgotten biliary stents: a case series and literature review

    OpenAIRE

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documen...

  4. Comparison of plastic and self-expandable metal stents in the palliative treatment of malignant biliary obstruction:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Kui Li; Zhongyin Zhou; Ximing Xu; Hesheng Luo

    2014-01-01

    Stent-placement-is-one-of-the-main-methods-in-the-pal-iative-treatment-of-malignant-biliary-obstruc-tion,-including-plastic-and-self-expandable-metal-stents.-The-comparison-of-stent-patency-between-self-expandable-metal-and-plastic-stents-in-pal-iation-of-malignant-biliary-obstruction-is-meaningful.-We-carried-out-a-meta-analysis-to-summarize-current-evidence-for-clinical-ef-icacy-of-self-expandable-metal-and-plastic-stents-in-the-treatment-of-malignant-biliary-obstruc-tion.-Methods:A-comprehensive-search-of-several-databases-including-CNKI,-Wanfang-Data,-Sino-MED.-A-fixed-ef-ects-or-random-ef-ects-model-was-used-to-pool-data-of-al-study-endpoint.-Sensitivity-analysis-was-also-performed.-Results:Eight-randomized-clinical-trials-were-identified,-including-633-patients.-These-results-suggested-that-the-self-expandable-metal-stents-were-associated-with-a-significantly-longer-stent-patency-(OR=8.15;95%CI:2.80-23.76;I2=85%).-No-publication-bias-was-observed.-Conclusion:Self-expanding-metal-stents-have-a-longer-patency-than-plastic-stents-and-of-er-adequate-pal-iation-in-patients-with-malignant-biliary-obstruction.

  5. Interventional treatment of biliary stent restenosis: recent progress in clinical management

    International Nuclear Information System (INIS)

    Malignant obstructive jaundice is biliary obstruction disorders which are caused by various malignant tumors. Usually the disease is at its advanced stage and is inoperable when the diagnosis is confirmed. At present, percutaneous transhepatic biliary drainage (PTCD) and endoscopic or interventional implantation of plastic or self-expanding metal stent (SEMS) are the main managements in clinical practice. Due to the improved survival time, biliary stent restenosis has become a quite common clinical problem. Photodynamic therapy (PDT) and biliary tract radiofrequency ablation (RFA) have provided new therapeutic means for clinical use. Especially, with its development in technology and equipment, RFA has played more and more important role in treating biliary stent restenosis. (authors)

  6. Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent.

    Science.gov (United States)

    Artifon, E L A; Takada, J; Okawa, L; Ferreira, F; Santos, M; Moura, E G H; Otoch, J P; Sakai, P

    2011-01-01

    Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques. PMID:22041320

  7. Long-term effects of forgotten biliary stents: a case series and literature review

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documents submitted by the patient did not indicate a replacement of the biliary stent in 3 patients. Two patients knew that they had biliary stents. We also conducted a literature review via the PubMed and Google Scholar databases of English language studies published until March 2014 on forgotten biliary stent. There were 3 men and 2 women ranging in age from 22 to 68 years (mean age 41.6 years). Patients presented with pain in the upper abdomen, jaundice, fever, abnormal liver function tests or dilatation of the biliary tract alone or in combination. Patients’ demographic findings are presented in Table 1. A review of three cases reported in the English medical literature also discussed. The mean duration of the patency of the stent is about 12 months. The biliary stenting is performed either with plastic or metal stents, studies recommending their replacement after 3-6 months. Patients with long stayed forgotten biliary stents are inevitably treated with surgical intervention. We recommend for all endoscopic retrograde cholangiopancreatography units provide a stent registry system that the stents placed for various therapeutic procedures are not forgotten both by the patient as well as the physician. There should be a deadline for biliary stents in the registry system for each patient. PMID:25232385

  8. Long-term effects of forgotten biliary stents: a case series and literature review.

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documents submitted by the patient did not indicate a replacement of the biliary stent in 3 patients. Two patients knew that they had biliary stents. We also conducted a literature review via the PubMed and Google Scholar databases of English language studies published until March 2014 on forgotten biliary stent. There were 3 men and 2 women ranging in age from 22 to 68 years (mean age 41.6 years). Patients presented with pain in the upper abdomen, jaundice, fever, abnormal liver function tests or dilatation of the biliary tract alone or in combination. Patients' demographic findings are presented in Table 1. A review of three cases reported in the English medical literature also discussed. The mean duration of the patency of the stent is about 12 months. The biliary stenting is performed either with plastic or metal stents, studies recommending their replacement after 3-6 months. Patients with long stayed forgotten biliary stents are inevitably treated with surgical intervention. We recommend for all endoscopic retrograde cholangiopancreatography units provide a stent registry system that the stents placed for various therapeutic procedures are not forgotten both by the patient as well as the physician. There should be a deadline for biliary stents in the registry system for each patient. PMID:25232385

  9. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9±4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct. (orig.)

  10. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Fanelli, Fabrizio; Orgera, Gianluigi; Bezzi, Mario; Rossi, Plinio; Allegritti, Massimiliano; Passariello, Roberto [University of Rome, Department of Radiological Sciences, Rome (Italy)

    2008-05-15

    To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9{+-}4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct. (orig.)

  11. Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

    OpenAIRE

    Hwang, Jae Chul; Kim, Jin Hong; Yoo, Byung Moo; Lim, Sun-Gyo; Kim, Jin Hun; Kim, Wook Hwan; Kim, Myung Wook

    2011-01-01

    Bile leaks remain a significant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration...

  12. A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

    International Nuclear Information System (INIS)

    Background. Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known. Methods. Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels. Results. Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors

  13. Anatomy-shaped design of a fully-covered, biliary, self-expandable metal stent for treatment of benign distal biliary strictures

    OpenAIRE

    Weigt, Jochen; Kandulski, Arne; Malfertheiner, Peter

    2015-01-01

    Background and study aims: The treatment success of benign biliary strictures with fully covered metal stents (CSEMS) is altered by high stent dislocation rates. We aimed to evaluate a new stent design to prevent dislocation. Patients and methods: Patients with benign biliary strictures were treated with a newly designed double-coned stent (dcSEMS). Mechanical analysis of the new stent was performed and it was compared with a cylindrical stent. Results: A total of 13 dcCSEMS were implanted in...

  14. Afterloading intracavitary irradiation and expanding stent for malignant biliary obstruction

    International Nuclear Information System (INIS)

    A double lumen catheter was developed as an apllicator for the remote afterloading (RALS) of 60Co source for the intracavitary irradiation of an obstructed common bile duct caused by carcinoma of the gallbladder. This was followed by the placement of nylon-covered expandable metallic stents to maintain patency. This combination effectively provided palliation. (author)

  15. Colonic perforations caused by migrated plastic biliary stents

    Energy Technology Data Exchange (ETDEWEB)

    Virgilio, Edoardo; Pascarella, Agauido; Scandavini, Chiara Maria; Frezza, Barbara; Bocchetti, Tommaso; Balducci, Genoveffa [Faculty of Medicine and Psychology ' Sapienza' , St. Andrea Hospital, Rome (Italy)

    2015-04-15

    Endoscopic insertion of plastic endoprostheses has become an integral part of the management of many benign and malignant diseases affecting the hepatobiliary and pancreatic system. Clogging and dislocation into the duodenum are the most frequently described complications following stent placement. Distal migration with or without perforation of the colon is an exceedingly rare phenomenon and the treatment is not well defined, as discussed below.

  16. Double Sigmoid colon perforation due to migration of a biliary stent.

    Science.gov (United States)

    Malgras, B; Pierret, C; Tourtier, J-P; Olagui, G; Nizou, C; Duverger, V

    2011-10-01

    Migration of pancreatico-biliary stents is a rare event, usually benign, but which can lead to severe complications such as digestive tube perforation. We report the case of a patient with double sigmoid perforation due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.

  17. Initial study of sediment antagonism and characteristics of silver nanoparticle-coated biliary stents in an experimental animal model

    Directory of Open Access Journals (Sweden)

    Tian Y

    2016-04-01

    Full Text Available Yigeng Tian,1,* Mingfeng Xia,2,* Shuai Zhang,3 Zhen Fu,4 Qingbin Wen,2 Feng Liu,4 Zongzhen Xu,4 Tao Li,4 Hu Tian4 1Department of Physics, School of Physics and Technology, University of Jinan, Jinan, Shandong, People’s Republic of China; 2Department of Surgery, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China; 3Department of General Surgery, Sixth People’s Hospital of Jinan, Jinan, Shandong, People’s Republic of China; 4Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People’s Republic of China *These authors contributed equally to this work Objective: Plastic biliary stents used to relieve obstructive jaundice are frequently blocked by sediment, resulting in loss of drainage. We prepared stents coated with silver nanoparticles (AgNPs and compared their ability to resist sedimentation with Teflon stents in a beagle model of obstructive jaundice.Methods: AgNP-coated Teflon biliary stents were prepared by chemical oxidation–reduction and evaluated in an obstructive jaundice model that was produced by ligation of common bile duct (CBD; animals were randomized to two equal groups for placement of AgNP-coated or Teflon control stents. Liver function and inflammatory index were found to be similar in the two groups, and the obstruction was relieved. Stents were removed 21 days after insertion and observed by scanning and transmission electron microscopy. The AgNP coating was analyzed by energy dispersive X-ray analysis (EDXA, and the composition of sediment was assayed by Fourier-transform infrared (FTIR spectroscopy.Results: Electron microscopy revealed a black, closely adherent AgNP stent coating, with thicknesses of 1.5–6 µm. Sediment thickness and density were greater on Teflon than on AgNP-coated stents. EDXA confirmed the stability and integrity of the AgNP coating before and after in vivo animal experimentation. FTIR

  18. Development of Stent Treatment for Malignant Biliary Duct Stenosis%恶性胆管狭窄的支架治疗进展

    Institute of Scientific and Technical Information of China (English)

    马丽

    2012-01-01

    胆管狭窄是一种常见的胆管疾病,一经发现多数病例已失去手术机会.胆管支架的置入可有效地解除胆管梗阻,提高患者的生活质量,延长生存期.目前常用的胆管支架有塑料支架和可扩张式金属支架两大类,两类支架各有利弊.现就胆管支架治疗胆管梗阻性疾病的相关内容进行综述.%Biliary duct stenosis is a common disease,once found,most cases have lost the chance of operation. Biliary stent placement can be effective in relieving biliary obstruction to improve the quality of life of patients and prolong the survival. Currently used biliary stents are plastic stents and expandable metal stents,each type with respective advantages and disadvantages. Here is to make a review on biliary stent treatment for biliary obstruction diseases and the related content.

  19. Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review.

    Science.gov (United States)

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Luigiano, Carmelo

    2015-08-14

    Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases. PMID:26290631

  20. Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders

    Directory of Open Access Journals (Sweden)

    Ahmed Abdel Samie

    2012-01-01

    Full Text Available Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES, and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause.

  1. Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review

    OpenAIRE

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H.; Luigiano, Carmelo

    2015-01-01

    Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert o...

  2. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  3. Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases

    OpenAIRE

    SHAO, JIN-HUI; FANG, HAI-XING; Li, Guo-Wei; HE, JIA-SHENG; Wang, Bao-Quan; Sun, Jun-Hui

    2015-01-01

    Malignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary and extra-biliary carcinomas. Generally, surgical resection is the primary treatment for malignant obstructive jaundice; however, for the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function. Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice. PTBD and stenting have...

  4. Post-metallic stent placement bleeding caused by stent-induced ulcers

    Institute of Scientific and Technical Information of China (English)

    Chun-Tao Wai; Christopher Khor; Siew-Eng Lim; Khek-Yu Ho

    2005-01-01

    Placement of self-expandable metal stents (SEMS) is an effective mode of palliative treatment for patients with malignant gastrointestinal obstruction. Gastrointestinal mucosal bleeding complicates about 5% of placement of SEMS but is not well described. We report three cases of gastrointestinal bleeding post-SEMS placement and suggest that bleeding is caused by direct mucosal infringement by the sharp edges of the ends of the stents.

  5. A STUDY OF DIAGNOSTIC ACCURACY AND UTILITY OF ULTRASOUND IN THE ASSESSMENT OF BILIARY STENT

    Directory of Open Access Journals (Sweden)

    Prashant U

    2015-09-01

    Full Text Available Ultrasound is cheap , easily available imaging modality which is useful in detection of stent within the biliary tree , dilatation of biliary tree and in assessment of complications after ERCP. AIMS AND OBJECTIVE: Our study aims at to statistic ally assess the diagnostic accuracy and utility of ultrasound in assessment of biliary stent. MATERIAL AND METHOD S : Total 221 patients from gastroenterology department were evaluated by ultrasound abdomen examination using Philips HD 11XE ultrasound scanne r. Post ERCP clinical details were obtained. X - ray abdomen done in all cases with ERCP is done wherever required. RESULT: In our study we found following measures of diagnostic accuracy in detection of biliary stent. Sensitivity 77.27% , Specificity 94.59% , Accuracy 85.97% , Positive predictive value 93.40% , Negative predictive value 80.76% , Positive likelihood ratio 14.29 , Negative likelihood ratio 0.24 , Diagnostic odds ratio 59.50. Twenty cases showed biliary dilatation in presence of CBD stent. Out of thes e 4 cases showed presence of upper end of stent in tumor mass while in rest cases it was in dilated biliary tree. Post ERCP complications were noted in 11 cases. CONCLUSION: Ultrasound is a reliable , noninvasive , nonradiative imaging modality to assess presence of biliary stent , biliary dilatation in presence of stent and to assess tumor status and post ERCP complications. Hence we recommend the use of follow up ultrasound after ERCP procedure.

  6. Predictors for occlusion of the first inserted metallic stent in patients with malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    Wandong Hong

    2015-01-01

    Full Text Available Background/Aims: Endoscopic biliary stent drainage plays an important role in the palliative treatment of malignant biliary obstruction. The aim of this study was to investigate predictors of occlusion of first metal inserted stent in patients with malignant biliary obstruction. Patients and Methods: The retrospective analysis was performed in 178 patients with malignant biliary obstruction. Factors associated with stent occlusion were analyzed by Cox regression analysis. Results: Median overall stent patency was 178 days. Total cumulative obstruction rate of the first stents during the follow up was 33%, 57%, 83%, and 96% at 90, 180, 360, and 720 days. Multivariate analysis revealed that hilar obstruction (hazard ratio [HR] =3.26, 95% confidence interval [CI, 2.31–4.61, metastasis cancer (HR = 2.61, 95% CI, 1.79–3.80, and length of stent (HR = 1.74, 95% CI, 1.24–2.46 were independent predictors of stent occlusion. Conclusions: Hilar biliary stricture, metastatic cancer, and length of stent were important predictors of occlusion of first-inserted metal stent in patients with malignant biliary obstruction.

  7. Stent placement for palliation of cor triatriatum dexter in a dog with suspected patent foramen ovale.

    Science.gov (United States)

    Barncord, Kristin; Stauthammer, Christopher; Moen, Sean L; Hanson, Melissa; Gruenstein, Daniel H

    2016-03-01

    An 11 month old spayed, female dog presented with exercise intolerance and cyanosis upon exertion. Echocardiography revealed an imperforate cor triatriatum dexter with mild tricuspid valve dysplasia, an underfilled right ventricle and significant right to left shunting across a presumptive patent foramen ovale. Balloon dilation of the abnormal atrial membrane was initially successful in creating a communication between the right atrial chambers, but stenosis of the original perforation and persistent clinical signs prompted a second intervention. A balloon expandable biliary stent was placed across the abnormal partition, improving caudal venous return to the right ventricle and reducing the right to left shunt. Three months after stent placement, resting oxygen saturation had normalized. Six months after stent placement, exercise tolerance had improved and exertional cyanosis had resolved. Long term follow up will be necessary to assess for remodeling of the right ventricle with improved venous return. Stent placement can be considered as a palliative treatment option for cor triatriatum dexter, especially for stenosis post-balloon dilation. PMID:26777393

  8. Angioplasty and stent placement - carotid artery

    Science.gov (United States)

    Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty; ... Carotid angioplasty and stenting (CAS) is done using a small surgical cut. Your surgeon will make a surgical cut ...

  9. Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing, self-expandable fully covered metal stent for palliative biliary drainage.

    Science.gov (United States)

    French, Joshua Blake; Coe, Adam Wesley; Pawa, Rishi

    2016-04-01

    In addition to the poor prognosis associated with pancreatic adenocarcinoma, it can also lead to several other conditions including obstructive jaundice that can affect a patient's quality of life. This is a major concern in non-operative patients where palliation is considered the main therapeutic goal. Traditionally, there are several ways to pursue palliative biliary drainage including endoscopic methods, a variety of surgical procedures, and percutaneous techniques. Generally, endoscopic methods such as endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stent placement are considered first-line therapies. Unfortunately, ERCP is not always possible due to several potential reasons. Although endoscopic ultrasound-guided biliary puncture has been well described for several years, there are limitations to its usefulness in biliary drainage, in part due to complication concerns. However, more recently a lumen-apposing, self-expandable fully covered metal stent has been employed for such situations. We describe two cases in which this type of stent was used in patients for palliative biliary drainage in pancreatic adenocarcinoma where standard ERCP was not feasible. In both cases, stent deployment was successful without immediate complications related to the procedure or the stent. Furthermore, the main goal of these therapies was palliation and in both cases the patient chose this procedure for quality of life reasons. In the future, randomized trials are needed to better define the long-term effectiveness and safety of these stents compared to more standard therapies. PMID:26956721

  10. Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients.

    Science.gov (United States)

    Hsieh, Jennifer; Thosani, Amar; Grunwald, Matthew; Nagula, Satish; Bucobo, Juan Carlos; Buscaglia, Jonathan M

    2015-10-01

    Controversy exists over the need for unilateral versus bilateral stent placement in patients with malignant obstruction at the biliary hilum. Placement of bilateral uncovered self-expanding metal stent (UCSEMS) at this location is technically challenging, and generally associated with lower rates of procedural success. Serial insertion of side-by-side UCSEMS may be especially difficult when simultaneous deployment is not possible using larger stent delivery catheters. In this single-center, retrospective case series of all patients who underwent bilateral placement of uncovered Wallflex(TM) biliary stents between July 2008 and July 2014, we evaluate the feasibility, technical success, and safety of patients undergoing serial insertion of bilateral UCSEMS using the 8 Fr Wallflex(TM) biliary system for malignant hilar obstruction. A total of 17 patients were included. Primary cholangiocarcinoma, Bismuth IV, was the most common diagnosis. Mean procedure time was 54.4 minutes. Overall procedural technical success was achieved in 17/17 patients. Stricture dilation was necessary prior to Wallflex(TM) insertion in 8/17 patients (47.1%). Transpapillary extension of two stents was performed in all patients. There were no cases of stent deployment malfunction, or inability to insert or deploy the 2(nd) stent. Nine of 17 patients (52.9%) required inpatient hospitalization following ERCP; the most common indications were abdominal pain and need for IV antibiotics. There was one case of ERCP-related cholangitis otherwise; there were no other major complications. Bilateral, serial insertion of UCSEMS using the 8 Fr Wallflex(TM) biliary system in malignant hilar obstruction is feasible with an excellent technical success profile. Using this device for side-by-side deployment of UCSEMS appears to be safe in the majority of patients. PMID:26605283

  11. A novel biliary stent coated with silver nanoparticles prolongs the unobstructed period and survival via anti-bacterial activity

    OpenAIRE

    Fuchun Yang; Zhigang Ren; Qinming Chai; Guangying Cui; Li Jiang; Hanjian Chen; Zhiying Feng; Xinhua Chen; Jian Ji; Lin Zhou; Weilin Wang; Shusen Zheng

    2016-01-01

    Symptomatic biliary stricture causes life-threatening complications, such as jaundice, recurrent cholangitis and secondary biliary cirrhosis. Fully covered self-expanding metal stents (FCSEMSs) are gaining acceptance for treatments of benign biliary stricture and palliative management of malignant biliary obstructions. However, the high rate of FCSEMS obstruction limits their clinic use. In this study, we developed a novel biliary stent coated with silver nanoparticles (AgNPs) and investigate...

  12. Trimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser

    OpenAIRE

    Zuber-Jerger, I.; F. Kullmann

    2009-01-01

    Biliary metal stents are a permanent solution for bile duct stenosis. Complications can arise when the stent migrates, breaks or is overgrown by tumour. The following case demonstrates how a Nd:YAG laser can be used to solve these problems. A 93-year-old man presented with jaundice and fever. Two years earlier a 6-cm metal stent had been implanted into a postinflammatory stenosis of the common bile duct after recurrent cholangitis and repetitive plastic stenting. Duodenoscopy showed that the ...

  13. Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists

    OpenAIRE

    Shim, Chan Sup; Kim, Jin Hong; Bok, Gene Hyun

    2016-01-01

    Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. ...

  14. Frequency and consequences of early in-stent lesions after carotid artery stent placement.

    NARCIS (Netherlands)

    Jongen, L.M.; Hendrikse, J.; Waaijer, A.; Worp, H.B. van der; Leijdekkers, V.J.; Lo, R.T.; Mali, W.P.Th.; Prokop, M.

    2009-01-01

    PURPOSE: To examine the prevalence of in-stent lesions 1 month after carotid artery stent placement with multidetector computed tomography (CT) angiography and to evaluate their possible causes and their consequences during 1-year follow-up. MATERIALS AND METHODS: Sixty-nine patients with symptomati

  15. Complications of stent placement for benign stricture of gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Ying-Sheng Cheng; Ming-Hua Li; Wei-Xiong Chen; Ni-Wei Chen; Qi-Xin Zhuang; Ke-Zhong Shang

    2004-01-01

    AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively.For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurredin 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain,reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures according to the specific conditions.

  16. Therapeutic transjejunal endoscopy for the treatment of biliary complications after choledochojejunostomy

    OpenAIRE

    Liu, Guo-Ping; Wen-xi ZHU; CHENG, GUANG-MING; Shu-ren MA

    2012-01-01

    The present study aimed to assess the value of endoscopic jejunostomy for post-biliary intestinal anastomosis biliary complications. The clinical data of the endoscopic therapies by jejunal approach for post-biliary intestinal anastomosis biliary complications in 13 patients (16 surgeries in total) were retrospectively analyzed. The surgical success rate was 100% (16/16). Nasobiliary tube detention was performed for 2 patients, plastic stent placement for 5 and biliary metal stent placement f...

  17. Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

    Directory of Open Access Journals (Sweden)

    Kei Ito

    2010-01-01

    Full Text Available We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low shortening ratio are expected to lessen the occurrence of complications characteristic of covered metal stents such as stent migration and bile duct kinking.

  18. 103Pd radioactive stent inhibits biliary duct restenosis and reduces smooth muscle actin expression during duct healing in dogs

    Institute of Scientific and Technical Information of China (English)

    Gui-Jin He; Qin-Yi Gao; Shu-He Xu; Hong Gao; Tao Jiang; Xian-Wei Dai; Kai Ma

    2006-01-01

    BACKGROUND: This study was designed to assess the expression of smooth muscle actin (SMA) in the healing process after implanting a 103Pd radioactive stent in the biliary duct, and to discuss the function and signiifcance of this stent in preventing biliary stricture formation. METHODS:A model of biliary injury in dogs was made and then a 103Pd radioactive stent was positioned in the biliary duct. The expression and distribution of SMA were assessed in the anastomotic tissue 30 days after implantation of the stent. RESULTS:SMA expression was less in the 103Pd stent group than in the ordinary stent group. The 103Pd stent inhibited scar contracture and anastomotic stenosis. CONCLUSION:The 103Pd stent can reduce the expression of SMA in the healing process and inhibit scar contracture and anastomotic stenosis in the dog biliary duct.

  19. Long-term effect of stent placement in 115 patients with Budd-Chiari syndrome

    Institute of Scientific and Technical Information of China (English)

    Chun-Qing Zhang; Li-Na Fu; Lin Xu; Guo-Quan Zhang; Tao Jia; Ji-Yong Liu; Cheng-Yong Qin; Ju-Ren Zhu

    2003-01-01

    AIM: To report the long-term effect of stent placement in 115 patients with Budd-Chiari syndrome (BCS).METHODS: One hundred and fifteen patients with BCS were treated by percutaneous stent placement. One hundred and two patients had IVC stent placement, 30 patients had HV stent placement, 17 of them underwent both IVC stent and HV stent. All the procedures were performed with guidance of ultrasound.RESULTS: The successful rates in placing IVC stent and HV stent were 94 % (96/102) and 87 % (26/30), respectively.Ninety-seven patients with 112 stents (90 IVC stents, 22 HV stents) were followed up. 96.7 %(87/90) IVC stents and 90.9 %(20/22) HV stents remained patent during follow up periods (mean 49 months, 45 months, respectively). Five of 112 stents in the 97 patients developed occlusion. Absence of anticoagulants after the procedure and types of obstruction (segmental and occlusive) before the procedure were related to a higher incidence of stent occlusion.CONCLUSION: Patients with BCS caused by short length obstruction can be treated by IVC stent placement, HV stent placement or both IVC and HV stent placement depending on the sites of obstruction. The long-term effect is satisfactory.Anticoagulants are strongly recommended after the procedure especially for BCS patients caused by segmental occlusion.

  20. Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study

    OpenAIRE

    Lee, Sang Soo; Song, Tae Jun; Joo, Mee; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2014-01-01

    Background/Aims To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS. Methods An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopatholo...

  1. Endo-biliary stents for benign disease: not always benign after all!

    Directory of Open Access Journals (Sweden)

    Jo-Etienne Abela

    2011-11-01

    Full Text Available This case report describes the presentation, management and treatment of a patient who suffered small bowel perforation due to the migration of his biliary stent which had been inserted for benign disease.

  2. Covered Self-Expanding Transhepatic Biliary Stents:Clinical Pilot Study

    International Nuclear Information System (INIS)

    Purpose: We report our preliminary results with a new type of self-expanding covered stent for treatment of malignant biliary obstruction. Methods: Wallstents, fully covered with high elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 69 mm, were placed transhepatically under fluoroscopic guidance in five patients. The length of the biliary obstruction varied between 30-50 mm. At 1 and 3 months (82-98 days) clinical assessment, serum bilirubin measurement, and ultrasound examination of the biliary tree were performed. Results: Initial uncomplicated deployment of the stents and internal drainage was possible in all patients. Distal stent migration resulted in early biliary reobstruction in one patient. At 3-month follow-up, partial reobstruction, most probably due to sludge formation, was found in another patient. Conclusion: Our initial results indicate that the covered, self-expanding Wallstent endoprosthesis can be reliably and safely deployed transhepatically for malignant biliary obstruction

  3. Stent placement for esophageal strictures : an update

    NARCIS (Netherlands)

    Hirdes, Meike Madeleine Catharine; Vleggaar, Frank Paul; Siersema, Peter Derk

    2011-01-01

    The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief

  4. 胆道及十二指肠恶性梗阻多支架置入治疗及体会%Experience of multiple biliary and duodenal stenting in the treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    施云星; 王广勇; 曾晓虹; 吕礁; 周国中; 刘长云; 覃林花

    2014-01-01

    Objective To investigate the therapeutic effects of combined biliary and duodenal stenting in the treatment of ma-lignant biliary and duodenal obstruction.Methods Medical data concerning 3 cases of malignant biliary and duodenal obstruction trea-ted with combined biliary and duodenal stenting in our hospital were summarized.PTCD biliary metallic stent placement was first per-formed in one patient with recurrent gastric tumor, and then duodenal stent insertion was done under gastroscopy.Biliary metallic stent and duodenal metal stenting was performed concurrently under duodenoscopy in one patient with periampullary cancer.Due to jaundice after surgery, biliary plastic stenting through duodenal metal stent mesh was performed in the patient.There was one patient with duode-nal cancer, who was first treated with inner and outer biliary drainage through PTCD, and then biliary metallic stent was placed through the sinus, and finally duodenal metal stenting was performed under duodenoscopy.Results Total bilirubin after stenting in the 3 pa-tients decreased significantly, and symptoms of upper digestive obstruction were improved considerably, and no serious complications occurred in the 3 patients.Conclusion Multiple metal stenting was an effective method for the treatment of malignant biliary and duo-denal obstruction, and could improve the life quality of patients as well.Methods for the placement of multiple stents could be different in one patient from another.%目的:探讨联合应用胆道支架及十二指肠支架治疗胆道及十二指肠恶性梗阻的疗效。方法总结我院3例胆道及十二指肠恶性梗阻患者行胆道及十二指肠支架治疗的资料。1例胃癌复发患者,先经皮经肝穿刺胆道引流术( PTCD)下胆道金属支架置入,然后行胃镜下胃十二指肠支架置入;1例壶腹周围癌患者,十二指肠镜下胆道金属支架及十二指肠内金属支架同时置入,术后因再次黄疸,经十二

  5. Covered metal stents in endoscopic therapy of biliary complications after liver transplantation.

    Science.gov (United States)

    Cantù, Paolo; Tenca, Andrea; Parzanese, Ilaria; Penagini, Roberto

    2016-08-01

    There is growing interest in using covered self-expandable metal stents for the treatment of benign biliary conditions, and the presence of anastomotic biliary strictures and leaks after liver transplantation provide a valuable opportunity for testing them. The performance of the stents is encouraging, and the technical success rate is high. They provide larger diameter dilation and are easily removed, and can potentially limit costs by reducing the number of procedures needed to treat anastomotic biliary strictures. However, drawbacks such as sub-optimal tolerability and migration may affect both patient management and costs. New stent designs are currently being evaluated. Randomized controlled trials and cost-effectiveness analyses comparing covered metal stents with multiple plastic stent endotherapy are warranted in order to define the role of the former as first-line or rescue treatment. PMID:27238164

  6. Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

    Institute of Scientific and Technical Information of China (English)

    Rakesh Rai; John Rose; Derek Manas

    2003-01-01

    AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable diseases.METHODS: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct obstruction.RESULTS: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the bleeding.CONCLUSION: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this case.So mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.

  7. A Double-Layered Covered Biliary Metal Stent for the Management of Unresectable Malignant Biliary Obstruction: A Multicenter Feasibility Study

    Science.gov (United States)

    Park, Jin-Seok; Jeong, Seok; Lee, Don Haeng; Moon, Jong Ho; Lee, Kyu Taek; Dong, Seok Ho

    2016-01-01

    Background/Aims The covered self-expandable metal stent (CMS) was developed to prevent tumor ingrowth-induced stent occlusion during the treatment of malignant biliary obstruction. However, complications such as cholecystitis, pancreatitis, and stent migration can occur after the endoscopic insertion of CMSs. The aim of the present study was to assess the efficacy and safety of a double-layered CMS (DCMS) for the management of malignant bile duct obstruction. Methods DCMSs were endoscopically introduced into 59 patients with unresectable malignant extrahepatic biliary obstruction at four tertiary referral centers, and the patient medical records were retrospectively reviewed. Results Both the technical and functional success rates were 100%. Procedure-related complications including pancreatitis, cholangitis, stent migration, and liver abscess occurred in five patients (8.5%). The median follow-up period was 265 days (range, 31 to 752 days). Cumulative stent patency rates were 68.2% and 40.8% at 6 and 12 months, respectively. At the final follow-up, the rate of stent occlusion was 33.9% (20/59), and the median stent patency period was 276 days (range, 2 to 706 days). Conclusions The clinical outcomes of DCMSs were comparable to the outcomes previously reported for CMSs with respect to stent patency period and complication rates. PMID:27172927

  8. Technical Tips and Issues of Biliary Stenting, Focusing on Malignant Hilar Obstruction

    OpenAIRE

    Lee, Tae Hoon

    2013-01-01

    Although there is no survival advantage, inoperable hilar cholangiocarcinoma managed by palliative drainage may benefit from symptomatic improvement. In general, biliary drainage is divided into endoscopic or percutaneous approaches and surgical drainage. Plastic or metal stent is the most preferred device for palliative drainage in endoscopic approach. Considering cost-effectiveness, use of metallic stent is preferred than plastic stents in patients with more than 3 months of life expectancy...

  9. A novel biliary stent coated with silver nanoparticles prolongs the unobstructed period and survival via anti-bacterial activity.

    Science.gov (United States)

    Yang, Fuchun; Ren, Zhigang; Chai, Qinming; Cui, Guangying; Jiang, Li; Chen, Hanjian; Feng, Zhiying; Chen, Xinhua; Ji, Jian; Zhou, Lin; Wang, Weilin; Zheng, Shusen

    2016-01-01

    Symptomatic biliary stricture causes life-threatening complications, such as jaundice, recurrent cholangitis and secondary biliary cirrhosis. Fully covered self-expanding metal stents (FCSEMSs) are gaining acceptance for treatments of benign biliary stricture and palliative management of malignant biliary obstructions. However, the high rate of FCSEMS obstruction limits their clinic use. In this study, we developed a novel biliary stent coated with silver nanoparticles (AgNPs) and investigated its efficacy both in vitro and in vivo. We first identified properties of the AgNP complex using ultraviolet detection. The AgNP complex was stable without AgNP agglomeration, and Ag abundance was correspondingly increased with an increased bilayer number. The AgNP biliary stent demonstrated good performance in the spin-assembly method based on topographic observation. The AgNP biliary stent also exhibited a long-term anti-coagulation effect and a slow process of Ag(+) release. In vitro anti-bacteria experiments indicated that the AgNP biliary stent exhibited high-efficiency anti-bacterial activity for both short- and long-term periods. Importantly, application of the AgNP biliary stent significantly prolonged the unobstructed period of the biliary system and improved survival in preclinical studies as a result of its anti-microbial activity and decreased granular tissue formation on the surface of the anastomotic biliary, providing a novel and effective treatment strategy for symptomatic biliary strictures. PMID:26883081

  10. Hemobilia into a metallic biliary stent due to pseudoaneurysm. A case report

    International Nuclear Information System (INIS)

    A 48-year-old man with locally advanced pancreatic cancer underwent combined treatment with gemcitabine and proton radiation therapy. Because of subsequent obstruction of the common bile duct, a metallic biliary stent was placed and he received further gemcitabine chemotherapy. During chemotherapy, he developed an acute abdomen with a sudden-onset of tarry stool and jaundice. Gastroduodenoscopy revealed hemobilia from the biliary metallic stent. Contrast-enhanced abdominal computed tomography revealed the presence of a pseudoaneurysm arising from the right hepatic artery adjacent to the top of the stent. Hemostasis of the right hepatic artery pseudoaneurysm was achieved via transcatheter arterial embolization using cyanoacrylate. (author)

  11. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS),or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis,and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures,seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

  12. Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer

    Institute of Scientific and Technical Information of China (English)

    Iruru; Maetani; Tomoko; Nambu; Shigefumi; Omuta; Takeo; Ukita; Hiroaki; Shigoka

    2010-01-01

    Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forwardviewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary meta...

  13. Polyurethane-Covered Self-expandable Nitinol Stent for Malignant Biliary Obstruction: Preliminary Results

    International Nuclear Information System (INIS)

    Purpose: To evaluate the immediate and long-term results in ten patients with malignant biliary obstruction using a polyurethane-covered, self-expandable nitinol stent.Methods: A nitinol stent, fully covered with high-elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 60-80 mm, was placed transhepatically under fluoroscopic guidance in ten patients. The length of the biliary obstruction varied between 30-50 mm. The follow-up examination included a clinical assessment, serum bilirubin measurement, and ultrasound examinations at one-month intervals in all patients. Results: Initial stent deployment was successful in eight patients. Two patients experienced proximal migration,which was solved by insertion of two, uncovered Wallstents. One patient had the stent removed after two weeks because of severe nausea and vomiting. One patient had delayed migration of the covered stent after 40 weeks. The follow-up duration was 3-40 weeks (Mean: 16.9 weeks). Seven patients died(3-26 weeks) and three patients survived (24-40 weeks). The bilirubin measurements in all patients had significantly decreased one week after stent insertion. The levels of amylase and lipase had did not increase after stent insertion. Conclusions: Apolyurethane-covered, self-expandable nitinol stent can be used effectively and safely in the treatment of malignant biliary obstruction. The preliminary results are favorable, but there is a need for further large studies to determine both long-term survival and patency

  14. Treatment of biliary stricture by percutaneous transhepatic insertion of metallic stent

    International Nuclear Information System (INIS)

    Purpose: Percutaneous transhepatic insertion of biliary stent (PTIBS) was adopted for treating malignant and benign biliary stricture. The therapeutic effect, technique and complications were investigated. Materials and methods: Twenty-five patients with biliary stricture were treated by PTIBS, including hilar biliary cancer 16 cases, pancreatic cancer 4 cases, hilar metastatic cancer 3 cases, and post-operative biliary stricture of bile duct 2 cases. Results: The technical success rate was 96.0% (24/25). Two stents were placed in the right and left hepatic ducts respectively in 2 cases. The survival rate of 6 and 12 months were 73.3% and 46.6%. Restenosis rate was 40.0% in 6 months. Mild hemobilia (44.0%) and retrograde infection (8.0%) were the main complications which could be managed by conservative treatment. Conclusion: It was suggested that PTIBS was a safe and effective method in the treatment of biliary stricture. There was higher success rate of PTIBS as compared to endoscopic retrograde biliary, approach especially in patients with hilar biliary stricture. If combined with chemotherapy, the survival rate of malignant biliary stricture could be further improved

  15. Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

    OpenAIRE

    Kei Ito; Naotaka Fujita; Yutaka Noda; Go Kobayashi; Takashi Obana; Jun Horaguchi; Shinsuke Koshita; Yoshihide Kanno; Takahisa Ogawa; Yuhei Kato; Yasunobu Yamashita

    2010-01-01

    We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low sho...

  16. Self-expandable metallic stents for malignant biliary obstruction: Efficacy on proximal and distal tumors

    Institute of Scientific and Technical Information of China (English)

    Jui-Hao Chen; Cheuk-Kay Sun; Chao-Sheng Liao; Chain-Smoke Chua

    2006-01-01

    AIM: To compare the efficacy of self-expandable metallic stents (EMS) in the treatment of distal and proximal stricture of malignant biliary tumors.METHODS: From March 1995 to June 2004, 61 patients (40 males, 21 females) with malignant biliary obstruction who received self-expandable metallic stent implantation were reviewed retrospectively. The stents were inserted by an endoscopic or percutaneous transhepatic method.We tried to place two stents in the biliary system in T or Y configuration in cases of hilar tumors with bilateral hepatic duct obstruction. The end points of the study were stent occlusion or patient death.RESULTS: The mean time of stent patency was 421 ±67d in the group of proximal stricture( group Ⅰ) and 168 ±18 d in the group of distal stricture (group Ⅱ). The difference was significant in borderline between the two groups (P=0.0567). The mean survival time was 574±76 d in group Ⅰ and 182±25 d in group Ⅱ. There was a significant difference between the two groups (P=0.0005).CONCLUSION: EMS implantation is a feasible, palliative method for unresectable malignant biliary obstruction.The clinical efficacy of EMS in patients with proximal hilar tumors is better than that in patients with distal tumors.

  17. The expression of p16, p53 induced by metallic biliary stent in canine

    International Nuclear Information System (INIS)

    Objective: To explore the value of the metallic biliary stents in inducing the expression of anti-oncogenes. Methods: The biliary stents were implanted in the inferior segments of CBD after a percutaneous transhepatic puncture at cholecyst in 24 dogs. After a generally observing time of half a year, the median abdominal incisions were made on the dogs under general anesthesia and the bile duct wall covered by the stents (group I) and uncovered (group II) were cut respectively. The expression of p16, p53, p15, Bcl-2 and K-ras in bile duct wall were detected by RT-PCR, and the positive rates of these gene expression were calculated. The differences between the two groups were analyzed by chi-square test for the statistics. Results: The animal models were successfully set in 20 of 24 dogs. The positive rates of p16, p53 gene expression were 80% (16/20), 45% (9/20) in the bile duct wall covered by the stents and 15% (3/20), 0% in the bile duct wall uncovered respectively, there were significant differences between the two groups (χ2=16.94, 9.17, P0.05). Conclusion: The enhancement of p16, p53 gene expression have some correlations with the implantation of metallic biliary stents. The biliary stenting is strongly recommended for the patients with malignant obstructive jaundice when no contraindications exist. (authors)

  18. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  19. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    International Nuclear Information System (INIS)

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies

  20. Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists.

    Science.gov (United States)

    Shim, Chan Sup; Kim, Jin Hong; Bok, Gene Hyun

    2016-03-01

    Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. The authors are humbled and gratified to have been able to observe the development and application of these stents in Korea, first hand. In this article, the authors review the overall history of stenting with a specific focus on the development of stenting in Korea. The development of esophageal, gastroduodenal, biliary, and colonic stents in Korea are reviewed in this article from a chronological and historical point of view, and a personal account of some of the significant moments of stent development in Korea are described. PMID:26956192

  1. Limited Role for Biliary Stent as Surrogate Fiducial Marker in Pancreatic Cancer: Stent and Intratumoral Fiducials Compared

    Energy Technology Data Exchange (ETDEWEB)

    Horst, Astrid van der, E-mail: a.vanderhorst@amc.uva.nl [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Lens, Eelco; Wognum, Silvia; Jong, Rianne de [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Hooft, Jeanin E. van [Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Tienhoven, Geertjan van; Bel, Arjan [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2014-07-01

    Purpose: Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. Methods and Materials: Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). Results: The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, –2.6 to 4.2 mm). Conclusions: For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including

  2. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    OpenAIRE

    Testoni, Pier Alberto

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangio-pancreatography (ERCP) or endoscopic ultrasound (EUS), or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute ...

  3. Use of an introducer sheath for colonic stent placement

    Energy Technology Data Exchange (ETDEWEB)

    De Gregorio, Miguel A.; Mainar, Antonio; Alfonso, Eduardo; Gimeno, Maria Jose [Department of Interventional Radiology, University Hospital of Zaragoza, C/ San Juan Bosco, 15, 50009 Zaragoza (Spain); Tejero, Eloy [Department of Surgery, University Hospital of Zaragoza, C/ San Juan Bosco, 15, 50009 Zaragoza (Spain); Herrera, Marcos [Department of Radiology, Hennepin County Medical Center, Minneapolis, MN 55408 (United States)

    2002-09-01

    We describe a technical modification of Wallstent implantation for the treatment of malignant rectosigmoid and descending colonic obstructions. The modification is the routine placement of an introducer sheath via the rectum before stent implantation in order to straighten the rectosigmoid region. This device facilitates catheter and guide wire manipulations and obtaining specimen biopsies for histopathological studies. The introducer sheath has been used without complications in 21 consecutive patients. (orig.)

  4. Biliary small intestinal submucosa covered Z-stents. Preliminary results in an animal model

    International Nuclear Information System (INIS)

    Background. Purpose of the study was to test the function and biological response of metallic stents covered with small intestinal submucosa (SIS) in the swine biliary system. Materials and methods. A total of 9 SIS-covered single Z-stents were placed in the common bile duct (CBD) in 6 pigs. Stents were delivered into the CBD at laparotomy via the gall bladder and the cystic duct. Animals were sacrificed or died at 2 weeks (n=1), 4 weeks (n=1), 8 weeks (n=2), and 10 weeks (n=2) after stenting and histological studies were performed. Results. Nine stents were deployed in 6 animals. During follow-up, 3 stents in 3 animals (2, 4, and 10 weeks) remained stable, while one stent shifted distally in CBD and 5 of them turned sideways. All stents remained patent. Duct dilatation and bile slugging were noted at 10 weeks. The SIS-membrane was present at 2 weeks, but was not histologically distinct at 4 weeks and later. Histological study showed no significant inflammatory changes in the bile duct in any pig. Mucosal hyperplasia was absent in 2 of 3 stable stents at 2 and 10 weeks, and 1 distally shifted stent at 10 weeks. Mild mucosal hyperplasia was seen at the distal stent end in 1 stable stent at 4 weeks and in 5 dislodged stents at 8 and 10 weeks. Conclusions. Even when the study is limited by dislodgment of high percentage of placed stents, the results in stable stents conducting the bile flow suggest that SIS helps to prevent bile duct inflammation and mucosal hyperplasia typical for uncoated stents. Further studies, particularly with improved wet SIS are warranted. (author)

  5. Covered Metal Stenting for Malignant Lower Biliary Stricture with Pancreatic Duct Obstruction: Is Endoscopic Sphincterotomy Needed?

    OpenAIRE

    Kazunari Nakahara; Chiaki Okuse; Keigo Suetani; Yosuke Michikawa; Shinjiro Kobayashi; Takehito Otsubo; Fumio Itoh

    2013-01-01

    Aims. To evaluate the need for endoscopic sphincterotomy (EST) before covered self-expandable metal stent (CSEMS) deployment for malignant lower biliary stricture with pancreatic duct obstruction. Methods. This study included 79 patients who underwent CSEMS deployment for unresectable malignant lower biliary stricture with pancreatic duct obstruction. Treatment outcomes and complications were compared between 38 patients with EST before CSEMS deployment (EST group) and 41 without EST (non-EST...

  6. Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

    OpenAIRE

    Afshar M; Khanom K; Ma YT; Punia P

    2014-01-01

    Mehran Afshar,1 Koudeza Khanom,2 Yuk Ting Ma,1,3 Pankaj Punia1 1Cancer Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; 2St James Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 3School of Cancer Sciences, University of Birmingham, Birmingham, UK Purpose: Stenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstr...

  7. Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Jin Hyoung; Lim, Jin-Oh; Kim, Kyung Rae [Asan Medical Center, Radiology and Research Institute of Radiology, Seoul (Korea); Song, Ho-Young [Asan Medical Center - Radiology, Songpa-gu, Seoul (Korea); Park, In Kook [Dongguk University, Life Science, Seoul (Korea); Choi, Eugene K. [Weill Medical College of Cornell University, New York, NY (United States)

    2008-11-15

    The purpose of this study was to evaluate the usefulness of a multifunctional gastrointestinal coil catheter for stent placement in 98 patients with colorectal strictures. The catheter was used in 98 consecutive patients for stent placement in the rectum (n = 24), recto-sigmoid (n = 13), sigmoid (n = 38), descending (n = 6), transverse (n = 11), splenic flexure (n = 3), hepatic flexure (n = 2), and ascending (n = 1) colon. The catheter was made of a stainless steel coil (1.3 mm in inner diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the catheter was evaluated depending on whether the catheter could pass a stricture over a guide wire and whether measurement of the stricture length was possible. The passage of the catheter over a guide wire beyond the stricture was technically successful and well tolerated in 93 (94.9%) of 98 patients. In the failed five patients, it was not possible to negotiate the guide wire due to presence of nearly complete small bowel obstruction. The average length of stricture was 6.15 cm (range, 3 cm to 20 cm) in patients with the colorectal stricture. There were no procedure-related complications. In conclusion, the multifunctional coil catheter seems to be useful in colorectal stent placement. (orig.)

  8. Shortening of Wallstent RP during carotid artery stenting requires appropriate stent placement.

    Science.gov (United States)

    Aikawa, Hiroshi; Nagata, Shun-ichi; Onizuka, Masanari; Tsutsumi, Masanori; Iko, Minoru; Kodama, Tomonobu; Nii, Kouhei; Matsubara, Shuko; Etou, Hosei; Go, Yoshinori; Kazekawa, Kiyoshi

    2008-06-01

    Changes in the location and length of the Wallstent RP during carotid artery stenting (CAS) were evaluated using intraoperative videos of 28 patients with carotid artery stenosis who underwent CAS with a 10/20 mm Wallstent RP to determine the appropriate stent placement. The stent was deployed after its midpoint was positioned over a virtual center line, the perpendicular line which crossed the most stenotic point of the lesion on the road mapping image. The length of the stenotic lesion, the changes in the locations of the distal and proximal ends of the stent, and the changes in stent length were examined. The distal end of the stent moved a maximum of 6.1 mm toward the proximal side to a point 19.9 mm from the virtual center line. The proximal end moved a maximum of 11.3 mm toward the distal side to a point 14.7 mm from the virtual center line. The stent length ranged from 37.7 to 44.5 mm (mean 41.2 mm). The 10/20 mm Wallstent RP placed by our technique covers the entire lesion with no less than 5.7 mm of margin over the segment distal to the lesion in patients with stenotic segments shorter than 29.4 mm.

  9. Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

    Directory of Open Access Journals (Sweden)

    Afshar M

    2014-12-01

    Full Text Available Mehran Afshar,1 Koudeza Khanom,2 Yuk Ting Ma,1,3 Pankaj Punia1 1Cancer Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; 2St James Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 3School of Cancer Sciences, University of Birmingham, Birmingham, UK Purpose: Stenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstruction and palliation of symptoms, little information is available on predictive factors for survival post-procedure. This retrospective study sought to assess factors influencing post-procedure survival in cancer patients after biliary stenting. Methods: Case notes of all patients from a regional academic cancer center, who underwent biliary stenting for obstructive jaundice related to malignancy during 2008 and 2009 were reviewed. We collected epidemiological, biochemical, treatment and survival data on all patients. We used Kaplan–Meyer analysis to assess survival from day of first biliary stenting (adjusted for cancer types, and the Cox proportional hazards model for univariate and multivariate analysis. Results: One hundred and ninety-four patients were included in the final analysis. Most cases were related to pancreatic cancer or cholangiocarcinoma (89 and 46 cases respectively. Median survival for all patients was 143 days. In multivariate analysis serum albumin ≥34 g/L at the time of procedure (hazard ratio 0.573; 95% confidence interval 0.424–0.773, P<0.001 and chemotherapy post-stent (hazard ratio 0.636; 95% confidence interval 0.455–0.889, P=0.008 were two independent prognostic factors predicting a better survival post-stenting. The 30 day mortality post-procedure in the 194 patients was 12%. Conclusion: This study suggests that stenting of the biliary tree in cases of malignant obstruction allows durable palliation of symptoms even in

  10. Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture

    OpenAIRE

    Joo, Kyu Re; Paik, Chang Nyol; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin Mo

    2013-01-01

    The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

  11. Biliary drainage of the common bile duct with an enteral metal stent

    OpenAIRE

    dek, I.M.; Elzen, van den, CMJ; Fockens, P.; Rauws, E A J

    2009-01-01

    In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that pr...

  12. Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming

    OpenAIRE

    Cho, Nam Jun; Lee, Tae Hoon; Park, Sang-Heum; Lee, Han Min; Hyun, Kyung Hee; Lee, Suck-Ho; Chung, Il-Kwun; Kim, Sun-Joo

    2013-01-01

    Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent remov...

  13. Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience

    OpenAIRE

    Xu-Hua Duan; Yan-Li Wang; Xin-Wei Han; Jian-Zhuang Ren; Teng-Fei Li; Jian-Hao Zhang; Kai Zhang; Peng-Fei Chen

    2015-01-01

    Objectives To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion. Methods Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative c...

  14. Feasibility and efficacy of stent placement in the treatment of hepatic artery stenosis after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility and efficacy of stent placement for the treatment of hepatic artery stenosis (HAS) after liver transplantation. Methods: Thirteen patients were proved to be HAS by angiography after liver transplantation. Twelve of them were treated with stent placement, 1 patient only received pereutaneous transluminal angioplasty (PTA). Stent placement techniques and the clinical data of 13 eases were retrospectively analyzed. Results: Among 13 patients with HAS, 11 patients were successfully treated with stent placement. During 9-227 days of follow-up (mean, 97 days), no intrastent restenosis was found by Doppler sonography. In 7 patients with less than 2 weeks diagnosis-therapy intervals, the elevated liver enzyme and/or bilirubin became normal after stent placement in 6 patients except 1 patient died of multiple organ failure at 9 days after the procedure; while in 4 patients with more than 2 weeks diagnosis-therapy intervals, 1 patient died of septicemia due to repeated bile duct infection and liver function failure, the other 3 patients still had repeated bile duct infection, which was improved after endoscopic retrograde cholangiopancreatography (ERCP) and drainage. Conclusion: Stent placement for HAS after liver transplantation is feasible. Catheter-sheath and coronary artery stents can be used to improve stent placement success. Early diagnosis and therapy are the critical factors for the efficacy of stent placement. (authors)

  15. Recurrent TIPS Failure Associated with Biliary Fistulae: Treatment with PTFE-Covered Stents

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction in human subjects with identified or suspected biliary fistulae. Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis. TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient using a custom-made PTFE-covered Gianturco Z-stent. Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the native portal venous system was treated with partial success by mechanical thrombolysis. Conclusion: Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable

  16. Very late stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked aneurysm.

    Science.gov (United States)

    Lee, Chang-Young; Kim, Chang-Hyun

    2015-02-01

    The crossing Y-stent technique is a viable option for coiling of wide-necked bifurcation aneurysms. However, little is known about the long-term impact of this technique. Very late (>1 year) stent thrombosis following the placement of a crossing Y-stent with dual closed-cell stents for the coiling of a wide-necked basilar tip aneurysm, which has not been reported to date, is described.

  17. Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer

    OpenAIRE

    Maetani, Iruru; Nambu, Tomoko; Omuta, Shigefumi; Ukita, Takeo; Shigoka, Hiroaki

    2010-01-01

    Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a ...

  18. Biliary drainage of the common bile duct with an enteral metal stent

    Institute of Scientific and Technical Information of China (English)

    Irene M Dek; Bram DJ van den Elzen; Paul Fockens; Erik AJ Rauws

    2009-01-01

    In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances. We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD, placement of an enteral metal stent in the CBD could be considered, especially in patients who are unfit for surgery.

  19. Percutaneous therapy of inoperable biliary stenoses and occlusions with a new self-expanding nitinol stent (SMART); Perkutane Therapie inoperabler maligner Stenosen und Verschluesse der Gallenwege mit einem neu entwickelten selbstexpandierbaren Nitinolstent (SMART)

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, N.; Lenhart, M.; Strotzer, M.; Paetzel, C.; Hamer, O.; Feuerbach, S.; Link, J. [Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik

    2002-10-01

    Objective: To evaluate the treatment of malignant biliary stenoses and occlusions using a new stent. Methods: In a prospective study, 25 patients with malignant obstructive jaundice were treated with SMART stents. The handling and the quality of stent expansion were documented. Stent function was assessed 2-4 days after intervention by cholangiography and laboratory tests. A follow-up was performed three months, after stent placement. Results: All lesions were treated successfully, with a total of 35 stents implanted. In 14 patients a further balloon dilatation was performed after stent placement (8-10 mm diameter/40-80 mm length). The mean serum bilirubin level decreased significantly from 11.6 mg/dl to 4.6 mg/dl after intervention (p<0.05). The follow-up showed a mean serum bilirubin level at 4.0 mg/dl. In 4 cases (16%) a further intervention (PTCD or stent) was performed. Six patients died due to tumor progression. The stents proved to be patent in 79% (n=15) of patients alive at the time of follow-up. Conclusions: Placement of the SMART stent for the therapy of malignant biliary lesions yields good technical and clinical results. (orig.) [German] Zielsetzung: Evaluation der technischen Handhabung und Effizienz eines neu entwickelten Stents zur Therapie maligner Gallenwegsstenosen und Verschluesse. Material und Methodik: In einer prospektiven Studie wurden 25 Patienten mit Verschlussikterus bei maligner Gallengangsstenose palliativ mit dem SMART {sup trademark} -Stent behandelt. Evaluiert wurden die Handhabung des Stents und die Qualitaet der Stententfaltung. Die Stentfunktion wurde nach 2-4 Tagen ueber eine liegende interne/externe Drainage cholangiographisch sowie anhand des Verlaufs der Laborparameter kontrolliert. Eine zusaetzliche Kontrolle der Stentfunktion erfolgte nach drei Monaten. Dabei wurden das subjektive Wohlbefinden des Patienten, der aktuelle Gesamtbilirubinspiegel im Serum und die Anzahl weiterer, im Nachsorgezeitraum durchgefuehrter

  20. Endoscopic removal and trimming of distal self-expandable metallic biliary stents

    Institute of Scientific and Technical Information of China (English)

    Kentaro Ishii; Fuminori Moriyasu; Akihiko Tsuchida; Takao Itoi; Atsushi Sofuni; Fumihide Itokawa; Takayoshi Tsuchiya; Toshio Kurihara; Shujiro Tsuji; Nobuhito Ikeuchi; Junko Umeda

    2011-01-01

    AIM: To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents (SEMS). METHODS: All SEMS had been placed for distal biliary strictures. Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS (one uncovered and 18 covered) removal had been attempted, and 8 patients in whom stent trimming using argon plasma coagulation (APC) had been attempted at Tokyo Medical University Hospital. The APC settings were: voltage 60-80 W and gas flow at 1.5 L/min. RESULTS: The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d (range, 8-280 d). Of the 19 patients in whom removal of the SEMS had been attempted, the procedure was successful in 14 (73.7%) without procedure- related adverse events. The indwelling period in the stent removable group was shorter than that in the unremovable group (94.9 ± 71.5 d vs 166.2 ± 76.2 d, P = 0.08). Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage. Trimming time ranged from 11 to 16 min. CONCLUSION: Although further investigations on larger numbers of cases are necessary to accumulate evidence, the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.

  1. Endoscopic management of occluded biliary uncovered metal stents:A multicenter experience

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; Kostas Fasoulas; Stefanos Atmatzidis; Christos Zavos; Jannis Kountouras; Athanasios Beltsis; Grigoris Chatzimavroudis; Dimitris Paikos; George Paroutoglou; Dimitris Kapetanos; Sotiris Terzoudis; Georgia Lazaraki; Ioannis Pilpilidis

    2011-01-01

    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.

  2. Antireflux metal stent with an antimigration system for distal malignant biliary obstruction: a feasibility pilot study.

    Science.gov (United States)

    Hamada, Tsuyoshi; Isayama, Hiroyuki; Nakai, Yousuke; Togawa, Osamu; Kogure, Hirofumi; Takahara, Naminatsu; Mohri, Dai; Sasaki, Takashi; Matsubara, Saburo; Yamamoto, Natsuyo; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2015-06-01

    An antireflux metal stent (ARMS) for distal malignant biliary obstruction has been reported to be useful, but the effectiveness of a flared-end structure to prevent migration on ARMS remains unclear. To evaluate the feasibility of a newly designed ARMS with both ends flared, 8 patients with covered metal stent occlusion due to sludge or food impaction were enrolled. ARMS were placed successfully after endoscopic removal of the occluded stents in all patients, and no procedure-related complication was observed. The median time to recurrent biliary obstruction was 71 days. ARMS occlusion occurred in 3 (38%) patients (sludge in 2 patients and hemobilia in 1). ARMS migration occurred in 1 (13%) patient. As a late complication, cholecystitis occurred in 1 (13%) patient. In conclusion, our newly designed ARMS with an antimigration system was technically feasible and safe, and a further investigation is warranted to evaluate the effectiveness of the current antimigration system. PMID:25856131

  3. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial

    NARCIS (Netherlands)

    S.M. Jeurnink; E.W. Steyerberg; J.E. van Hooft; C.H.J. van Eijck; M.P. Schwartz; F.P. Vleggaar; E.J. Kuipers; P.D. Siersema

    2010-01-01

    BACKGROUND: Both gastrojejunostomy (GJJ) and stent placement are commonly used palliative treatments of obstructive symptoms caused by malignant gastric outlet obstruction (GOO). OBJECTIVE: Compare GJJ and stent placement. DESIGN: Multicenter, randomized trial. SETTING: Twenty-one centers in The Net

  4. The Evolution and Current Utility of Esophageal Stent Placement for the Treatment of Acute Esophageal Perforation.

    Science.gov (United States)

    Herrera, Argenis; Freeman, Richard K

    2016-08-01

    Esophageal stent placement was used primarily for the treatment of malignant strictures until the development of a new generation of biomaterials allowed the production of easily removable, occlusive stents in 2001. Since then, thoracic surgeons have gained experience using esophageal stents for the treatment of acute esophageal perforation. As part of a hybrid treatment strategy, including surgical drainage of infected spaces, enteral nutrition, and aggressive supportive care, esophageal stent placement has produced results that can exceed those of traditional surgical repair. This review summarizes the evolution of esophageal stent use for acute perforation and provides evidence-based recommendations for the technique. PMID:27427525

  5. Cost comparison of gastrojejunostomy versus duodenal stent placement for malignant gastric outlet obstruction

    NARCIS (Netherlands)

    Jeurnink, S. M.; Polinder, S.; Steyerberg, E. W.; Kuipers, E. J.; Siersema, P. D.

    2010-01-01

    Gastrojejunostomy (GJJ) and stent placement are the most commonly used palliative treatments for malignant gastric outlet obstruction (GOO). In a recent randomized trial, stent placement was preferred in patients with a relatively short survival and GJJ in patients with a longer survival. As health

  6. The use of self expandable metallic stent in the management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Self expandable metallic stent is a good alternative of percutaneous transhepatic biliary drainage because it can eliminate numerous problems caused by external drainage catheter, such as tube dislodgement, bile leakage and psychotic problems. Authors analyzed initial results of self expandable metallic stents used in the patient with malignant biliary obstruction to evaluate the efficacy of the procedure and to find the technical problems in the procedure. Self expandable metallic stents were inserted in 14 patients: three with recurrent stomach cancer: three with gallbladder cancer: seven with Klaskin tumor: one with common duct cancer. Gianturco type stent was used in 9 cases ans Wallstent was used in 2 cases. In remaining three case, both Z-stent and Wallstent were used in the same patient. The average period of follow up was 104 days (4-409 days). In 13 cases, the patency of the bile duct was restored by the stent (technical success: 92.9%). Occlusions of the stent were found in two cases, after two and 13 months, respectively. Causes of failure and stent occlusion were associated duodenal obstruction, tumor overgrowth and shortening of Wallstent. In remaining 11 patients, one patient was lost to follow up an 10 patients did not show recurrent jaundice until death or last follow up. There was no major complication related to the procedure. The insertion of self expandable metallic stent is a safe procedure and can eliminate major disadvantages of PTBD. Overstenting, overlapping and evaluation of associated GI tract obstruction is crucial for obtaining technical success and long-term patency

  7. Retrievable Airway Stent Placement for Stoma Stricture after Anterior Mediastinal Tracheostomy: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Jae Yeon; Shin, Ji Hoon; Kim, Yong Hee; Song, Ho Young; Kim, Jin Hyoung [Dept. of University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, Yeoun Joo [Dept. of Pediatrics, Pusan National University Children' s Hospital, Yangsan (Korea, Republic of)

    2013-06-15

    Anterior mediastinal tracheostomy (AMT) is performed to establish an airway after resection of advanced tumors in the cervicothoracic region. We report a case of successful placement of a covered retrievable self-expandable nitinol stent for a stoma stricture that developed after AMT in a patient with adenoid cystic carcinoma of the trachea. Two stent placements and removals, at two and three months after their initial placement, were performed due to loosening of the stents. Although we did not achieve long-term results as the patient died of massive hemorrhage, the stent placement was both feasible and safe, thus suggesting that temporary stent placement may be a valuable option for treating stoma stricture occurring after AMT.

  8. Retrievable Airway Stent Placement for Stoma Stricture after Anterior Mediastinal Tracheostomy: Case Report

    International Nuclear Information System (INIS)

    Anterior mediastinal tracheostomy (AMT) is performed to establish an airway after resection of advanced tumors in the cervicothoracic region. We report a case of successful placement of a covered retrievable self-expandable nitinol stent for a stoma stricture that developed after AMT in a patient with adenoid cystic carcinoma of the trachea. Two stent placements and removals, at two and three months after their initial placement, were performed due to loosening of the stents. Although we did not achieve long-term results as the patient died of massive hemorrhage, the stent placement was both feasible and safe, thus suggesting that temporary stent placement may be a valuable option for treating stoma stricture occurring after AMT.

  9. Endovascular stent-graft placement for treatment of type B dissections

    Institute of Scientific and Technical Information of China (English)

    俞飞成

    2006-01-01

    Objective To evaluate the safety and effectiveness of endovascular stent-graft placement for treatment of type B dissection. Methods From April 2002 to December 2005,180 patients with type B dissection underwent endovascular stent-graft placement. There were 158 men and 22 women with mean age of 50. 4±10. 9 years. All patients were diagnosed by computed tomography(CT) or magnetic resonance imaging (MRI) scans. Stent-graft

  10. Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

    Energy Technology Data Exchange (ETDEWEB)

    Li, Mingwu, E-mail: lmw-jack@china.com.cn; Bai, Ming, E-mail: mingbai1983@gmail.com; Qi, Xingshun, E-mail: qixingshun19840717@126.com; Li, Kai, E-mail: lkiscoming@163.com; Yin, Zhanxin, E-mail: yinzhanxin@sina.com [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China); Wang, Jianhong, E-mail: 54526844@qq.com [Fourth Military Medical University, Department of Ultrasound, Xijing Hospital of Digestive Diseases (China); Wu, Wenbing, E-mail: wuwb211@126.com; Zhen, Luanluan, E-mail: zll2007101@163.com; He, Chuangye, E-mail: sxhechuangye@126.com [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China); Fan, Daiming, E-mail: fandaim@fmmu.edu.cn [Fourth Military Medical University, State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases (China); Zhang, Zhuoli, E-mail: Zhuoli-Zhang@northwestern.edu [Northwestern University, Department of Radiology (United States); Han, Guohong, E-mail: hangh2009@gmail.com, E-mail: Hangh@fmmu.edu.cn [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China)

    2015-06-15

    AimTo investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting (PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction (MHO).Methods159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The stents were technically successful in all patients. Successful drainage was achieved in 114 patients (71.4 %). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88, 71, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantly affect therapeutic success, early major complications, median stent patency, or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success (odds ratio = 0.262, 95 % confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla (7.1 vs. 20.3 %, respectively, p = 0.03).ConclusionsThe majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.

  11. Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

    International Nuclear Information System (INIS)

    AimTo investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting (PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction (MHO).Methods159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The stents were technically successful in all patients. Successful drainage was achieved in 114 patients (71.4 %). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88, 71, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantly affect therapeutic success, early major complications, median stent patency, or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success (odds ratio = 0.262, 95 % confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla (7.1 vs. 20.3 %, respectively, p = 0.03).ConclusionsThe majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate

  12. Usefulness of multiplanar reformatted images of multi-detector row helical CT in assessment of biliary stent patency

    International Nuclear Information System (INIS)

    To evaluate the usefulness of multi-detector row helical CT (MDCT), multiplanar reformatted images for the noninvasive assessment of biliary stent patency, and for the planning for management in patients with a sele-expandable metallic stent due to malignant biliary obstruction. Among 90 consecutive patients, from August 1999 to July 2003, 26 cases in 23 patients with malignant biliary obstruction who underwent self-expandable metaIlic stent insertion in the biliary system and percutaneous transhepatic biliary drainage within 7 days after CT were enrolled in this study. On CT images, the complete and functional obstruction of the stent and the precise level of obstruction were evaluated. The presence of an enhancing intraluminal mass or wall thickening around stent was determined, and the causes of obstruction were evaluated. These findings were then compared with percutaneous transhepatic cholangiography. Multi-detector row helical CT correctly demonstrated the patency of a stent in 24 cases (92.3%). It was adequate in helping to depict the precise level of stent occlusion in 23 cases (88.5%). Multi-detector row helical CT also revealed the extent of tumor that represented as an enhancing intraluminal mass or wall thickening around the stent in 23 cases, and this was represented as complete obstruction on percutaneous transhepatic cholangiography. In the case of functional obstruction, MDCT predicted the possible cause of the obstruction. Multiplanar reformatted images of multi-detector row helical CT is a useful imaging modality for the noninvasive assessment of stent patency and the precise level of obstruction when stent obstruction is suspected in the patients with self-expandable metallic stent due to malignant biliary obstruction. It can also predict the possible cause of the obstruction and allows adequate planning for the medical management of such cases

  13. Percutaneous expandable metallic stent biliary endoprostheses used inmalignant and benign obstructive jaundice

    Institute of Scientific and Technical Information of China (English)

    Hai Ying Liu; Wei Hua Tong; Wei Min Hu; Huai Ren Li; Zhe Sheng Wen; Jia Kang Wang; Wan Xi Huang; Shu Liu

    2000-01-01

    AIM To evaluate the effects of expandable metallic stent biliary endoprostheses (EMSBE) viaultrasonographic guided percutaneous transhepatic approach on the treatment of benign and malignantobstructive jaundice.METHODS Thirty-eight patients with obstructive jaundice (29 males and 9 females) aged 27 to 69 years(mean 54.7 years) were studied. Of them, 4 were benign and 34 malignant obstructions. Percutaneoustranshepatic cholangiography (PTC) was performed under ultrasonic guidance. A catheter was introducedinto the dilated bile duct via the introducer. A guide wire was inserted through the occlusive part of biliary duct after dilating with a double-lumen balloon catheter. A self-expandable metallic stent was inserted intcthe occlusive bile duct under fluoroscopic control.RESULTS The success rate of sonographic guided PTC was 100% (38/38) and the success rate of stentimplantation was 86.8% (33/ 38). Biliary obstruction was eliminated immediately, jaundice subsidedgradually and symptoms relieved after the procedure. During the 3 to 28 months fellow-up, re-occlusionoccurred in 4 malignant cases which were corrected by balloon catheter dilation and/or by stent, one patienthad secondary cholangitis and fifteen died without jaundice 6 - 28 months after the procedure. The otherswere alive with no jaundice. No severe complications or side effects were observed.CONCLUSION EMSBE via sonographic guided percutaneous transhepatic approach is a reliable and safepalliative therapy for malignant jaundice and an ideal nonoperative method for benign biliary obstruction. Ithas a definite positive impact on the quality of patient life.

  14. Treatment of malignant stenosis of biliary tract with introduction of percutaneous selfexpandible metallic stent

    International Nuclear Information System (INIS)

    On a case of a female patients with malignant biliary stenosis the author presents his first experiences with selfexpandible metallic stent. The main indications of percutaneous insertion of stents are inoperable malignant biliary stenoses. In this case, there was an inoperable ventricular carcinoma with metastatic involvement of porta hepatitis and left lobe of the liver with extrahepatic bile duct stenosis, diagnosed by ERCP (endoscopic retrograde cholangio-pancreaticography) USG (ultrasonography) and PTC (percutaneous transhepatic cholangiography). Despite of repeated attempts the endoscopic internal drainage has failed. Because of malignant jaundice - PTC had been performed and just then, PTBD (percutaneous transhepatic biliary drainage) without direst communication between the biliary tree and duodenum. Twelve days after the procedure we performed an external-internal (combinated) drainage by pushing the catheter to duodenum and thus - outflow of bile to the duodenum was secured even throughout the extrahepatic portion of the bile duct. Ten days later, after these initial drainage procedures a selfexpendible metallic stent has been inserted into the extrahepatic bile duct and sufficient drainage to duodenum has been reached. (author)

  15. Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement

    International Nuclear Information System (INIS)

    Purpose: To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC). Methods: Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C. Results: Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10–119 days). Stent patency was preserved in six patients with clinical success until death. Conclusion: Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.

  16. Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ye Jin; Kim, Jin Hyoung, E-mail: m1fenew@daum.net; Song, Ho-Young; Park, Jung-Hoon; Na, Han Kyu; Kim, Pyeong Hwa; Fan, Yong [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center (Korea, Republic of)

    2012-10-15

    Purpose: To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC). Methods: Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C. Results: Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10-119 days). Stent patency was preserved in six patients with clinical success until death. Conclusion: Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.

  17. Medical Devices; Gastroenterology-Urology Devices; Classification of the Metallic Biliary Stent System for Benign Strictures. Final order.

    Science.gov (United States)

    2016-07-13

    The Food and Drug Administration (FDA) is classifying the metallic biliary stent system for benign strictures into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the metallic biliary stent system for benign strictures' classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:27411238

  18. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Aytekin, Cueneyt E-mail: cuneytaytekin@hotmail.com; Boyvat, Fatih; Yagmurdur, Mahmut Can; Moray, Goekhan; Haberal, Mehmet

    2004-01-01

    Objective: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. Methods and Material: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. Results: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. Conclusion: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

  19. Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

    Directory of Open Access Journals (Sweden)

    Jalal Vahedian Ardakani

    2013-10-01

    Full Text Available Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

  20. Brachytherapy for the prevention of neointimal hyperplasia in the canine inferior vena cava after stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Isota, Masayuki; Kaminou, Toshio; Sakai, Yukimasa; Nakamura, Kenji; Yamada, Ryusaku [Osaka City Univ. (Japan). Medical School

    2002-06-01

    The aim of this study was to evaluate the efficacy of brachytherapy for preventing neointimal hyperplasia in the inferior vena cava (IVC) after stent placement. Sixteen beagles underwent Z-stent placement in the IVC and the aorta. For 8 of 16 beagles, irradiation (15 Gy) was delivered endoluminally to the stented segments of each vessel immediately after stent placement using the {sup 192}Ir. All animals were sacrificed after 6 weeks for morphometric and histopathologic examination. Morphometrically, neointimal thickness in the IVC of the radiation group was significantly decreased compared with the control group as well as that in the aorta (p<0.05). Histopathologic findings showed the neointima in the IVC of the control group contained markedly organization of thrombus and neovascularization though that in the IVC of the radiation group consisted mainly of smooth muscle cells without organization of thrombus and neovascularization. From these data intravenous irradiation may prevent clinical restenosis after stent placement. (author)

  1. The treatment for malignant obstructive jaundice by biliary stent placement by ERCP or PTCD (an analysis of 68 cases)%经皮逆行胰胆管造影术或经皮经肝胆管引流术放置胆管支架治疗恶性梗阻性黄疸(附68例分析)

    Institute of Scientific and Technical Information of China (English)

    张皞; 黄平; 张啸

    2011-01-01

    目的 探讨经内镜逆行胰胆管造影术(ERCP)联合改良法经皮经肝胆管引流术(PTCD)治疗恶性梗阻性黄疸的优越性.方法 68例恶性梗阻性黄疸患者先通过EKCP放置胆道支架,ERCP不成功则通过改良法PTCD窦道放置.观察其操作成功率、退黄效果、并发症发生情况、支架通畅期及患者生存期.结果 68例患者中58例通过ERCP成功置入内支架,8例行PTCD经窦道放入金属支架,2例均未能成功,成功率97.1%;所有患者术后瘙瘁、腹痛及发热等临床症状明显改善,肝功能各项转氨酶指标及胆红素水平迅速下降;7例患者支架再次阻塞,1例患者反复发作胆管炎,并发症发生率为11.8%;塑料支架通畅期平均为112 d;金属支架通畅期平均为212 d;患者生存期最短为68d,最长为540d,平均为238d.结论 ERCP及改良法PTCD创伤小,疗效好,可作为无法手术切除或不愿手术的恶性梗阻性黄疸患者的首选治疗.%[Objective]To investigated the superiority of ERCP (endoscopic retrograde cholangiopancreatography) combining improved PTCD (percutaneous transhepatic biliary drainage) in the treatment of the patients with malignant obstructive jaundice.[Methods]68 patients with malignant obstructive jaundice were placed biliary stents through ERCP firstly, and PTCD after ERCP is unsuccessful.The operation success rate, the palliative level of jaundice, the rate of complication, the stent patency period and the survival period of patientswere observed.[Results]Of 68 patients with malignant obstructive jaundice, 58 cases were placed biliary stents via ERCP; 8 via PTCD after it faied.The success rate was 97.1%.Two failed in the stent implantation via either ERCP or PTCD.The clinical symptoms such as pruritus, abdominal pain and fever were improved obviously and the liver function indicators of transaminase and bilirubin levels decreased rapidly in all patients; Stent obstruction happened on 7 cases, recurrent cholangitis

  2. Choledochoduodenal Fistula after the Placement of a Partially Covered Metal Stent for Unresectable Pancreatic Cancer.

    Science.gov (United States)

    Masuda, Daisuke; Ogura, Takeshi; Imoto, Akira; Onda, Saori; Sano, Tatsushi; Takagi, Wataru; Okuda, Atsushi; Takeuchi, Toshihisa; Fukunishi, Shinya; Inoue, Takuya; Higuchi, Kazuhide

    2016-01-01

    A 75-year-old Japanese man with type 2 diabetes mellitus suffered from unresectable pancreatic head cancer and was admitted to our institution due to acute cholangitis. A partially covered metal stent was placed at that time. 11 months later, he was readmitted for acute cholangitis. Upper endoscopy revealed complete stent distal migration and a small hole on the oral side of the ampulla. While attempting cannulation into the hole, an upstream biliary tract was revealed. Accordingly, we diagnosed the patient to have a choledochoduodenal fistula. After metal stent removal and balloon dilation, we placed two 7 Fr plastic stents, which successfully relieved the patient's cholangitis. PMID:27301511

  3. Successful biliary drainage using a metal stent through the gastric stoma.

    Science.gov (United States)

    Matsumoto, Kazuyuki; Kato, Hironari; Tsutsumi, Koichiro; Akimoto, Yutaka; Uchida, Daisuke; Tomoda, Takeshi; Yamamoto, Naoki; Noma, Yasuhiro; Horiguchi, Shigeru; Okada, Hiroyuki; Yamamoto, Kazuhide

    2015-06-28

    We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We initially performed endoscopic retrograde cholangiopancreatography (ERCP) with a trans-oral approach. However, neither the side-viewing endoscope nor the ultrathin endoscope passed through the esophageal orifice. Thus, we eventually performed ERCP via the PEG stoma using an ultrathin endoscope. We performed biliary drainage with a 6F introducer self-expanding metal stent. The cytology findings obtained by brush cytology showed malignancy. Her laboratory results were restored to normal levels after drainage and no complication occurred. PMID:26140009

  4. Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Sang-Heum Park; Sang Pil Kim; Ji-Young Park; Chang Kyun Lee; Il-Kwun Chung; Hong Soo Kim; Sun-Joo Kim

    2009-01-01

    Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery.Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

  5. Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

    Directory of Open Access Journals (Sweden)

    Xu-Hua Duan

    Full Text Available To determine the safety and feasibility of intraductal radiofrequency ablation (RFA followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days. With a median follow-up of 384 days (range 187-544 days, six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

  6. Successful biliary drainage using a metal stent through the gastric stoma

    OpenAIRE

    Matsumoto, Kazuyuki; Kato, Hironari; Tsutsumi, Koichiro; Akimoto, Yutaka; UCHIDA, DAISUKE; Tomoda, Takeshi; Yamamoto, Naoki; Noma, Yasuhiro; Horiguchi, Shigeru; Okada, Hiroyuki; Yamamoto, Kazuhide

    2015-01-01

    We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We...

  7. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction.

    OpenAIRE

    O'Brien, S.; Hatfield, A R; P. I. Craig; Williams, S P

    1995-01-01

    Effective palliation of malignant biliary obstruction with conventional 10 or 12 French gauge straight polyethylene endoprostheses is limited by stent occlusion, which typically occurs four to five months after insertion. Short term follow up studies of self expanding metal stents (Wallstent, Schneider, UK) in the treatment of patients with malignant biliary obstruction have shown that their use is associated with fewer episodes of stent occlusion compared with plastic stents. There are few d...

  8. Endoscopic ultrasound-guided biliary drainage using a lumen-apposing self-expanding metal stent: a case series.

    Science.gov (United States)

    Brückner, Stefan; Arlt, Alexander; Hampe, Jochen

    2015-09-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) might be an alternative to percutaneous or transpapillary biliary drainage in unresectable pancreatic or biliary cancer. A lumen-apposing, fully covered, self-expanding metal stent, which creates a sealed transluminal conduit between the biliary and gastrointestinal tract may offer advantages over conventional plastic and metal stents. In this retrospective, observational, open-label case study, five patients underwent EUS-BD for obstructive jaundice in pancreatic cancer (n = 4) or distal cholangiocarcinoma (n = 1). Technical and functional success was achieved in all patients without complications. The development of specialized stent and delivery systems may render EUS-BD an effective and safe alternative to percutaneous or transpapillary approaches. PMID:26021309

  9. Efficacy of Covered Metallic Stents in the Treatment of Unresectable Malignant Biliary Obstruction

    International Nuclear Information System (INIS)

    We evaluated the efficacy of covered stents for malignant biliary obstruction. We studied 62 patients with obstruction distal to the hilar confluence who survived longer than 10 weeks and divided them into a covered stent group (group 1, n = 22), a Z stent group (group 2, n = 19), and a mesh stent group (group 3, n = 21), according to their type of the stent. Patency rates of each group were compared. Early stent revision was required after 3 days in 18% (4/22) of group 1, 26% (5/19) of group 2, and 0% (0/21) of group 3. The 10, 20, and 40-week primary patency rates were 77%, 77%, and 59% (group 1), 42%, 25%, and 8% (group 2), and 76%, 71%, and 55% (group 3), respectively. Primary patency rates of groups 1 and 3 were significantly higher than those of group 2 (p < 0.05), and there was no statistically difference between those of group 1 and group 3. The 10, 20, and 40-week assisted primary (secondary) patency rates were 96%, 96%, and 96% (group 1), 68%, 49%, and 39% (group 2), and 86%, 74%, and 58% (group 3), respectively. Assisted primary patency (secondary) rates of group 1 were significantly higher than those of groups 2 and 3 (p < 0.01 and p < 0.05, respectively). Our study suggests that the primary patency rates of the covered stents are equal to those of mesh stents, but these may be improved further if covered stents, which avoid the need for early revision, are used

  10. Clinical evaluation of radiotherapy for advanced esophageal cancer after metallic stent placement

    Institute of Scientific and Technical Information of China (English)

    You-Tao Yu; Guang Yang; Yan Liu; Bao-Zhong Shen

    2004-01-01

    AIM: To evaluate the therapeutic effect of radiotherapy for esophageal cancer after expandable metallic stent placement.METHODS: Ten cases of advanced esophageal cancer were evaluated, 7 having complete obstruction and 3 with digestive-respiratory fistula. Ten nitinol stents were placed at the site of stenosis. Patients were treated with a total dose of 1 200 cGy divided into 3 fractions of 400 cGy 4-7 d after stents placement.RESULTS: All the 10 stents were placed successfully at one time. After radiotherapy for advanced esophageal cancer, the survival period of the cases ranged from 14 to 22 mo, with a mean survival of 17 mo. No re-stenosis occurred among all the 10 cases.CONCLUSION: Stent placement combined with radiotherapy for esophageal cancer is helpful to prolong patients' survival and reduce occurrence of re-stenosis.

  11. Operation Cooperation and Nursing of Endoscopic Biliary Stent Implantation%经内镜胆道支架置入术的手术配合及护理

    Institute of Scientific and Technical Information of China (English)

    卢翠勤

    2015-01-01

    目的:探讨经内镜胆道支架置入术的护理配合。方法回顾2010年7月-2014年12月我院50例经内镜胆道支架置入术患者术前、术后护理及术中配合。结果所选取的病例胆管狭窄部位及长度均经ERCP进行确定,经透视引导置入已选择好的支架。塑料支架组40例,金属支架组10例。术后患者黄疸均明显减退,胆道通畅期为4-25个月。结论术前加强与患者及其家属的沟通,使患者积极配合治疗;术中医护配合,确保支架成功置入;术后精心护理是经内镜胆道支架置入术有效治疗胆道疾病的重要保障。%Objective To explore the nursing cooperation in the clinical application of endoscopic biliary stent placement. Methods 50 cases of our hospital from July 2010 to December were treated by endoscopic biliary stent implantation, postoperative care and intraoperative cooperation.Results The location and length of bile duct stricture were determined by ERCP, and the selection of the selected cases was good. Plastic stent group, 40 cases, metal stent group, 10 cases. After surgery, patients with jaundice decreased significantly, the symptoms improved, and the bile duct patency period was 4-25 months.Conclusion Preoperative strengthen communication with patients and their families, so that patients actively cooperate with the treatment; operative doctor nurse cooperation to ensure successful stent implantation; careful postoperative nursing care is endoscopic biliary stenting is effective in the treatment of biliary tract disease is an important guarantee.

  12. Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Dong O Kang; Tae Hyo Kim; Seung Suk You; Hyun Ju Min; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee

    2008-01-01

    Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However,blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident.We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

  13. Biliary Metal Stent as a Nidus for Bile Duct Stone

    OpenAIRE

    Cheon, Young Koog; Moon, Jong Ho; Cho, Young Deok; Kim, Yun Soo; Lee, Moon Sung; Shim, Chan Sup

    2002-01-01

    Several cases of recurrent stone formation caused by a surgical material as a nidus have been reported. Recently, we experienced one case in which a migrated metal stent might have been served as a nidus for common duct stone formation. The diagnosis was confirmed by ERCP, the stone was successfully removed with endoscopic therapy. Six years ago, she had undergone a lithotripsy using a percutaneous cholangioscopy (PTCS) because of intrahepatic cile duct stoes. Six years later, she developed a...

  14. Angioplasty and stent placement in chronic occlusion of the superficial femoral artery: technique and results.

    OpenAIRE

    Conroy, RM; Gordon, IL; Tobis, JM; Hiro, T; Kasaoka, S; Stemmer, EA; Wilson, SE

    2000-01-01

    PURPOSE: To improve the patency rate for angioplasty in chronic occlusion of the superficial femoral artery by deploying stents after angioplasty. MATERIALS AND METHODS: Angioplasty and stent placement were performed in 61 arteries in 48 male patients. The mean occlusion length was 13.5 cm and the mean stent length was 30 cm. Patency rates were analyzed at 6 months and at 1, 2, 3, and 4 years. The predictors of restenosis were analyzed by univariate and multiple logistic regression. RESULTS: ...

  15. Stone extraction balloon-guided repeat self-expanding metal stent placement

    Institute of Scientific and Technical Information of China (English)

    Hyung; Hun; Kim; Jeong; Seop; Moon; Soo; Hyung; Ryu; Jung; Hwan; Lee; You; Sun; Kim

    2010-01-01

    Self-expanding metal stent (SEMS) placement offers safe and effective palliation in patients with upper gastrointestinal obstruction due to a malignancy. Well described complications of SEMS placement include tumor growth, obstruction, and stent migration. SEMS occlusions are treated by SEMS redeployment, argon plasma coagulation application, balloon dilation, and surgical bypass. At our center, we usually place the second SEMS into the first SEMS if there is complete occlusion by the tumor. We discovered a...

  16. Induction of biliary cholangiocarcinoma cell apoptosis by 103Pd cholangial radioactive stent γ-rays

    Institute of Scientific and Technical Information of China (English)

    HE Gui-jin; DAI Chao-liu; SUN Dan-dan; JI Da-wei; SUI Dong-ming; YU Fa-qiang; GAO Qin-yi; DAI Xian-wei; GAO Hong; JIANG Tao

    2008-01-01

    Background In recent years, interventional tumor therapy, involving implantation of intra-cholangial metal stents through percutaneous trans-hepatic punctures, has provided a new method for treating cholangiocarcinoma, 103Pd cholangial radioactive stents can concentrate high radioactive dosages into the malignant tumors and kill tumor cells effectively, in order to prevent re-stenosis of the lumen caused by a relapsed tumor. The aim of the present study was to investigate the efficacy of y-rays released by the 103Pd biliary duct radioactive stent in treating cholangiocarcinoma via induction of biliary cholangiocarcinoma cell apoptosis.Methods A group of biliary duct cancer cells was collectively treated with a dose of y-rays. Cells were then examined by the 3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl terazolium-bromide (MTT) technique for determining the inhibition rate of the biliary duct cancer cells, as well as with other methods including electron microscopy, DNA agarose gel electrophoresis, and flow cytometry were applied for the evaluation of their morphological and biochemical characteristics. The growth curve and the growth inhibition rate of the cells were determined, and the changes in the ultrastructure of the cholangiocarcinoma cells and the DNA electrophoresis bands were examined under a UV-lamp.Results The y-ray released by 103Pd inhibited cholangiocarcinoma cell growth, as demonstrated when the growth rate of the cells was stunned by a γ-ray with a dosage larger than 197.321 MBq. Typical features of cholangiocarcinoma cell apoptosis were observed in the 197.321 MBq dosage group, while cell necrosis was observed when irradiated by a dosage above 245.865 MBq. DNA agarose gel electrophoresis results were different between the 197.321 MBq irradiation dosage group, the 245.865 MBq irradiation dosage group, and the control group.Conclusions 103Pd radioactive stents which provide a radioactive dosage of 197.321 MBq are effective in the treatment of

  17. Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis and Stent Dysfunction after Preoperative Biliary Drainage in Patients with Malignant Biliary Stricture.

    Science.gov (United States)

    Hashimoto, Shinichi; Ito, Kei; Koshida, Shinsuke; Kanno, Yoshihide; Ogawa, Takahisa; Masu, Kaori; Iwashita, Yuji; Horaguchi, Jun; Kobayashi, Go; Noda, Yutaka

    2016-01-01

    Objective To retrospectively evaluate the risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and stent dysfunction after performing preoperative biliary drainage (BD) in patients with malignant biliary stricture. Methods Between January 2003 and February 2013, 105 consecutive patients who had undergone transpapillary BD before surgery were enrolled in this study. Procedure-related complications, stent dysfunction rates, and their respective risk factors were investigated. PEP was defined according to the consensus guidelines. Results Fifty-five patients had bile duct cancer, 31 had pancreatic cancer, 16 had ampullary cancer, and 3 had gallbladder cancer. Endoscopic biliary stenting (EBS) and nasobiliary drainage (NBD) were performed in 84 patients and 21 patients, respectively. PEP occurred in 10% of the patients, with a significantly higher frequency in those with hilar/upper bile duct stricture (p=0.026) and a normal bilirubin level at admission (p=0.016). Of the 84 patients who underwent initial EBS, stent dysfunction occurred in 13%. The mean number of days from EBS to stent dysfunction was 14±12 days. A multivariate analysis revealed a male gender (p=0.048), a stent diameter ≤8 Fr (p=0.036), and an ERCP procedure time ≥45 minutes (p=0.021) to be risk factors for stent dysfunction. No NBD tube dysfunction was observed. Conclusion Patients with upper/hilar bile duct stricture or a normal bilirubin level are at high risk of developing PEP after preoperative BD. NBD or EBS with a large-bore stent is therefore recommended as preoperative BD. PMID:27629944

  18. Covered Metal Stenting for Malignant Lower Biliary Stricture with Pancreatic Duct Obstruction: Is Endoscopic Sphincterotomy Needed?

    Directory of Open Access Journals (Sweden)

    Kazunari Nakahara

    2013-01-01

    Full Text Available Aims. To evaluate the need for endoscopic sphincterotomy (EST before covered self-expandable metal stent (CSEMS deployment for malignant lower biliary stricture with pancreatic duct obstruction. Methods. This study included 79 patients who underwent CSEMS deployment for unresectable malignant lower biliary stricture with pancreatic duct obstruction. Treatment outcomes and complications were compared between 38 patients with EST before CSEMS deployment (EST group and 41 without EST (non-EST group. Results. The technical success rates were 100% in both the EST and the non-EST group. The incidence of pancreatitis was 2.6% in the EST, and 2.4% in the non-EST group (. The incidences of overall complications were 18.4% and 14.6%, respectively, (. Within the non-EST groups, the incidence of pancreatitis was 0% in patients with fully covered stent deployment and 3.6% in those with partially covered stent deployment (. In the multivariate analysis, younger age (, OR 12 and nonpancreatic cancer (, OR 24 were significant risk factors for overall complications after CSEMS deployment. EST was not identified as a risk factor. Conclusions. EST did not reduce the incidence of pancreatitis after CSEMS deployment in patients of unresectable distal malignant obstruction with pancreatic duct obstruction.

  19. Intraluminal brachytherapy after metallic stent placement in primary bile duct carcinoma

    International Nuclear Information System (INIS)

    To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstuction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (ρ<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8-16.1) and 8.3 (range, 0.8-17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9-8.0) and 5.0 (range, 0.9-8.4) months in those whom the procedure was not performed (ρ<0.05). Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma

  20. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    International Nuclear Information System (INIS)

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  1. ERCP胆管支架在恶性胆管梗阻中的临床应用#%Clinical Application of ERCP Biliary Stents in Malignant Biliary Obstruction

    Institute of Scientific and Technical Information of China (English)

    曾安祥; 刘波颖; 张德强; 曾德辉

    2014-01-01

    目的:为了进一步研究和探讨在采用胆管支架引流术治疗恶性胆管梗阻的实践过程中,分别采用金属支架和塑料支架实施治疗后的临床治疗效果差异,从而为临床实践研究提供可靠依据。方法:本文选取了我院2006年6月至2013年12月期间收治恶性胆管梗阻患者88例为研究对象,根据患者所采用支架的不同进行分组,分成金属支架组(16例)和塑料支架组(72例),观察两组患者采用不同临床治疗方法后的TBIL、ALT、ALP、GGT、TNF-α和30d后死亡发生率及支架阻塞发生率。结果:(1)在ALP、GGT、TNF-α等三项指标上,组间比较,金属支架组患者的指标水平均显著的优于塑料支架组;(2)在平均生存时间、支架开通时间两项指标上,组间比较,金属支架组患者均长于塑料支架组。结论:与采用塑料支架相比较,采用金属支架实施ERCP胆管支架术治疗的效果更好,是临床针对恶性胆管梗阻实施胆管支架引流治疗的可靠选择。%To further study and discuss the differences of the clinical treatment of the application of metal stents and plastic stents in the course of malignant biliary stent drainage of bile duct obstruction, so as to provide reliable basis for clinical practice research.Methods:88 patients of malignant biliary obstruction from June 2006 to December 2013 in our hospital were chosen as the research object. According to the differences of stents, they were divided into the metal stent group (16 cases) and the plastic stent group (72 cases). The TBIL, ALT, ALP, GGT, TNF-α, and the incidence of mortality and incidence of stent occlusion after 30 days for the two groups after different clinical treatment methods were observed.Results: (1) In the three indicators of ALP, GGT, TNF-α, etc compared between the two groups, the indicator of the metal stents was signiifcantly better than the plastic stent group.(2) In the

  2. Efficacy of the New Double-Layer Stent for Unresectable Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study

    OpenAIRE

    Ken Ito; Yoshinori Igarashi; Takahiko Mimura; Yui Kishimoto; Yoshinori Kikuchi; Naoki Okano

    2012-01-01

    Background and Aims. For distal malignant biliary obstruction in cases with short life expectancy, occlusion of plastic stents (PSs) does not usually occur before death, and the application of such a procedure is considered adequate from the viewpoint of cost-effectiveness. Methods and Setting. A new commercially available DLS with side holes, a conventional DLS, and, uncovered self-expanding metal stents (SEMSs) were retrospectively evaluated in patients with jaundice due to unresectable dis...

  3. Malignant obstructive jaundice treated by endoscopic biliary stent insertion:An analysis of 21 cases%经内镜胆管支架引流术治疗恶性梗阻性黄疸21例

    Institute of Scientific and Technical Information of China (English)

    王宝友; 魏文俊; 潘宏年; 汪发勇

    2014-01-01

    目的:探讨经内镜胆管支架引流术治疗恶性梗阻性黄疸的疗效。方法回顾性分析21例经内镜胆管支架引流术治疗的恶性胆管梗阻性黄疸患者的临床资料。结果18例患者插管成功,插管成功率为85.71%,其中2例置入金属支架,16例置入塑料支架。成功置入支架的18例患者术后黄疸逐渐消退,皮肤瘙痒等症状明显缓解或消失,血清总胆红素从(230.85±83.81)μmol·L-1下降到术后1周(121.88±52.27)μmol·L-1(P<0.01),转氨酶也显著下降(P<0.01)。结论经内镜胆管支架引流术是姑息治疗恶性梗阻性黄疸的重要手段,疗效确切。%Objective To evaluate the clinical efficacy of endoscopic placement of biliary stents in the management of malignant ob-structive jaundice.Methods The clinical data of 21 patients who underwent placement of biliary stents for palliation of malignant bili-ary obstruction between 2010 and 2013 were retrospectively reviewed.Results The stents were placed successfully in 18 patients (85.71%).Two cases were successfully embedded with metal stents,16 cases were embedded with plastic stents.The serum level of totalbilirubin decreased from (230.85 ±83.81)μmol·L -1 to (121.88 ±52.27)μmol·L -1 after treatment (P <0.01).This was accom-panied by a significant decrease in aminotransferase.Conclusion Endoscopic placement of biliary stent is an effective palliation treat-ment for malignant biliary obstruction.

  4. Biliary Leak in Post-Liver-Transplant Patients: Is There Any Place for Metal Stent?

    OpenAIRE

    Michel Kahaleh; Timothy Schmitt; Melissa Phillips; Gaidhane, Monica R; Martins, Fernanda P

    2012-01-01

    Objectives. Endoscopic management of bile leak after orthotopic liver transplant (OLT) is widely accepted. Preliminary studies demonstrated encouraging results for covered self-expandable metal stents (CSEMS) in complex bile leaks. Methods. Thirty-one patients with post-OLT bile leaks underwent endoscopic temporary placement of CSEMS (3 partially CSEMS , 18 fully CSEMS with fins and 10 fully CSEMS with flare ends) between December 2003 and December 2010. Long-term clinical success and safety ...

  5. Managing malignant biliary obstruction in pancreas cancer: Choosing the appropriate strategy

    OpenAIRE

    Boulay, Brian R; Parepally, Mayur

    2014-01-01

    Most patients with pancreatic cancer develop malignant biliary obstruction. Treatment of obstruction is generally indicated to relieve symptoms and improve morbidity and mortality. First-line therapy consists of endoscopic biliary stent placement. Recent data comparing plastic stents to self-expanding metallic stents (SEMS) has shown improved patency with SEMS. The decision of whether to treat obstruction and the means for doing so depends on the clinical scenario. For patients with resectabl...

  6. Analysis of the placement of multiple metallic stents in the treatment of hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma, especially in the complex cases of which the hepatic ducts are invaded. Methods: Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses. The cause of hilar obstructions in these patients were all cholangiocarcinoma, including Bismuth classification type II (n 12), IIIa (n 17), IIIb (n 10), and IV (n 6). Two or 3 stents were placed in the configuration of T, Y or X over the strictures. Results: Stent placement with 2 or 3 endoprostheses was successful in all patients. All patients showed significant decrease in serum bilirubin level. The mortality rate within 30 days of stent placement was 2.2% (1/45). The mean survival and stent patency times were 215.3 d (26- 516 d) and 181.5 d (26-473 d), respectively. Conclusion: Deploying of multiple metallic stents is an effective method to treat complex hilar cholangiocarcinoma, especially for the cases of which hepatic ducts are invaded; the hepatic ducts should be drained as much as possible. (authors)

  7. Temporary mushroom like covered stent placement with transnasal esophageal fistula abscess drainage for gastroesophageal anastomotic fistula

    International Nuclear Information System (INIS)

    Objective: To investigate the therapeutic effects on gastroesophageal anastomotic fistula with temporary placing covered stent of mushroom shape and transnasal drainage of gastroesophageal anastomotic abscess. Methods: For 8 patients with gastroesophageal anastomotic fistula, under fluoroscopic guidance, the drainage tube was put into the abscess cavity through nasal cavity and esophageal fistula, then stent was implanted within the esophagus. The abscess cavity was aspirated and esophagogram was taken in suitable time. Retaining the drainage tube about one month and then the stent was withdrawn after one week of the taken out of the former. Results: The drainage of abscess and stent placement was successful. The drainage tube was pulled out during 14-21 days after placement. The stent should be removed within one month. All fistulas were closed up and the abscesses disappeared. Conclusions: It is a safe, efficient, complicationless, non-invasive method to treat gastroesophageal anastomotic fistula with temporary placing covered stent with mushroom shape and drainage of abscess through nasal cavity and esophagus. Temporary mushroom-like covered stent placement with transnasal gastroesophageal anastomotic abscess drainage is a safe efficient, complication-less non-invasive method used interventionally. (authors)

  8. Treatment of malignant and benign biliary obstructions with metal stents; Behandlung maligner und benigner biliaerer Obstruktionen mit Metallstents

    Energy Technology Data Exchange (ETDEWEB)

    Hausegger, K.A.; Kugler, C. [Graz Univ. (Austria). Radiologische Klinik

    2000-04-01

    The palliative treatment of malignant bilary tract obstructions using a metal stent is now an established procedure in clinical practice. An endoscopic, transpapillary approach is the first choice for implantation of the stent. If it is not possible to insert the stent in this way, which is often the case with high obstructions, a percutaneous approach is chosen. It appears to be beneficial to use a metal stent with a finemeshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plastic stents so that the primary choice of a metal stent is justified. Coated stents have not yet shown any major advantages. In cases of stent occlusion the coaxial implantation of a plastic stent seems to be the most efficient. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities and exploitation of balloon dilatation and long-term splinting methods. (orig.) [German] Die palliative Behandlung maligner Gallengangsobstruktionen mittels Metallstents ist ein in der klinischen Routine etabliertes Verfahren. Primaer wird der endoskopisch transpapillaere Zugang zur Stentimplantation gewaehlt. Ist eine Stentimplantation auf diesem Weg nicht moeglich, was bei hohen Obstruktionen haeufiger vorkommt, erfolgt die Stentimplantation ueber den perkutanen Zugang. Es scheint sinnvoll, Metallstents mit einem engen Gitternetz wie zum Beispiel den Wallstent zu verwenden. Metallstents haben eine hoehere Offenheitsrate als Plastikstents, so dass die primaere Implantation dieser Stents gerechtfertigt ist. Ummantelte Stents haben bisher keinen wesentlichen Vorteil gebracht. Bei Stentokklusion duerfte die koaxiale Implantation eines Plastikstents am effektivsten sein. Bei benignen Gallengangsstenosen sollten Metallstents nur nach gruendlicher Evaluation der chirurgischen Sanierungsmoeglichkeiten und Ausschoepfung der Moeglichkeiten der Ballondilatation und Langzeitschienung implantiert

  9. Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Chandra Shekhar Bhati; Chandrashekhar Kubal; Pankaj Kumar Sihag; Ankur Atal Gupta; Raj Kamal Jenav; Nicholas G Inston; Jagdish M Mehta

    2007-01-01

    AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy.METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted.RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable.CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.

  10. ePTFE/FEP-Covered Metallic Stents for Palliation of MalignantBiliary Disease: Can Tumor Ingrowth Be Prevented?

    International Nuclear Information System (INIS)

    Purpose. To determine the application and clinical effectiveness of ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease, and to evaluate the efficiency of stent coverage in preventing tumor ingrowth. Methods. During a 3-year period, 36 patients with malignant obstructive jaundice were treated with ePTFE/FEP-covered stents, with or without proximal side holes. The stricture was located in the lower common bile duct (CBD) in 18 cases, the upper CBD in 9, the lower common hepatic duct (CHD) in 6, and the upper CHD in 3 patients. Results.Thirty-seven covered stents were percutaneously implanted. The technical success rate was 97%. Reintervention was required in 6 cases. The 30-day mortality rate was 40%, not procedure-related. Mean survival was 128 days. Primary patency rates were 100%,55.5%, and 25% at 3, 6, and 12 months, respectively, while the assisted patency rate was 100% at 12 months. Stents without side holes had higher primary patency rates compared with those with side holes, where occlusion was always due to tumor ingrowth. Tumor ingrowth did not occur in the completely covered stents. No stent dysfunction due to sludge incrustation was found.Complications were 1 case of arterial laceration that occurred during percutaneous transhepatic cholangiography, and a subcapsular hematoma and 1 case of bile peritonitis, that both occurred during primary stenting. No complications followed the secondary stenting technique. Conclusion. ePTFE/FEP-covered metallic stents are safe and effective for palliation of malignant biliary disease. The presence of the ePTFE/FEP coating is likely to prevent from tumor ingrowth

  11. Stent placement under real-time MR control: first experience in an animal model

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to test the feasibility of iliac artery stent placement under MR guidance with real-time MR radial scanning in an animal model. Materials and methods: The experiments were performed on three pigs in a 1.5 T scanner. Radial scanning with a gradient echo technique (TR 8.4 ms, TE 3.6 ms, flip angle 10 ) was used. A dedicated backprojector performed the reconstruction of the raw data in real-time. The resulting MR-images were displayed on LCD screens beside the magnet. The sliding window reconstruction technique allowed image acquistion at a frame rate of 16 images per second. MR-compatible self-expanding stents with a diameter of 8 mm and a length of 3 cm were placed into the left iliac artery. Their positions were verified by digital subtraction angiography (DSA) and compared to MRI. Results: All stents were successfully placed. Stent positions as monitored by real-time MR were identical to those seen on DSA images. The time needed for exact positioning of the scan plane ranged from 15 to 30 minutes. Stent placement itself took 8 minutes on average. Conclusion: Radial scanning applied together with the sliding window reconstruction technique allows placement of stents in iliac arteries under realtime MR control. (orig.)

  12. Osteonecrosis of Femoral Head Occurred after Stent Placement of Femoral Artery

    Directory of Open Access Journals (Sweden)

    Akiyoshi Shimatani

    2014-01-01

    Full Text Available We present a case of osteonecrosis of femoral head (ONFH that occurred after stent angiography of femoral artery for the treatment of arteriosclerosis obliterans (ASO of left inferior limb in a 76-year-old woman. No case of late collapse of femoral head as a complication of endovascular procedure such as stent placement has been previously documented. We considered that ONFH occurred after detaining stent at a junction of left deep femoral artery for the treatment of the ischemia of left lateral and medial femoral circumflex artery.

  13. Percutaneous Endovascular Recanalization of a Thrombosed Aortic Graft Limb with Stent Placement.

    Science.gov (United States)

    Georgakarakos, Efstratios; Kapoulas, Konstantinos

    2014-06-01

    Common practice in recanalization of a thrombosed prosthetic graft limb in an aortoiliac bypass focuses on balloon-catheter thrombectomy and angiographic exploration followed either by open surgical revision or endovascular management. This report describes the technique of percutaneous endovascular recanalization of an early thrombosed aortic graft limb with stent placement and subsequent restoration of patency and adequate limb perfusion, which remains patent after one year. Percutaneous intervention with stent placement and angioplasty for early graft limb recanalization avoids femoral incisions, and complications or morbidity associated with open surgery, while permitting rapid mobilization of the patient. PMID:26798727

  14. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Taketo Yamaguchi; Takeshi Ishihara; Katsutoshi Seza; Akihiko Nakagawa; Kentarou Sudo; Katsuyuki Tawada; Teruo Kouzu; Hiromitsu Saisho

    2006-01-01

    AIM: Endoscopic metal stenting (EMS) offers good results in short to medium term follow-up for bile duct stenosis associated with chronic pancreatitis (CP);however, longer follow-up is needed to determine if EMS has the potential to become the treatment of first choice.METHODS: EMS was performed in eight patients with severe common bile duct stenosis due to CR After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while,the other five underwent EMS following plastic tube stenting. The patients were followed up for more than5 years through periodical laboratory tests and imaging techniques.RESULTS: EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure: one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS.None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.CONCLUSION: EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.

  15. Endovascular stent placement for the treatment of superficial femoral artery stenoses and occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seul Kee; Yang, Hee Sun; Han, Jae Hee; Yim, Nam Yeol; Yoon, Woong; Kim, Jae Kyu [Chonnam National University Hospital, Gwangju (Korea, Republic of); Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2008-04-15

    The aim of this study was to evaluate effectiveness of an endovascular stent placement in the treatment of superficial femoral artery stenoses and occlusions. An angioplasty and stent placement was performed in forty four patients (42 men and 2 women; mean age: 71.2 years; age range: 50-82 years). A total of 27 patients were diagnosed with intermittent claudication, in addition to 8 patients with resting pain, and 9 patients with gangrene. A follow-up evaluation accompanied with a physical examination, catheter angiography, and a color Doppler sonography was performed. The patency rates were analyzed after 3 months, 6 months, 1 year and 2 years. The predictors of restenosis, according to the clinical and anatomical classification, risk factors, as well as the correlation of stent fracture and restenosis were analyzed. Initial technical success was achieved in all patients. The stent placement resulted in an initial improvement of the clinical category in more than one level for 95.5% of cases. Over the course of the follow-up period (mean: 17 months; range, 1-106 months), restenosis occurred in 16 patients (36.4%). The highest patency rates were 87.9% after 3 months, 81.5% after 6 months, 78.0% after 1 year, 54.2% after 2 years, and 46.0% after 3 years. No significant difference was found for the patency rates as a function of the clinical and anatomical classifications, or the risk factors. A stent fracture was identified on only two occasions; however, no clinical symptoms or good intra-stent blood flow was observed in a follow-up angiography. A mid-term patency after the stent placements for superficial femoral artery stenoses and occlusions was found to be unfavorable despite an initial success rate. Consequently, greater clinical experience and analysis is necessary.

  16. Comparison of Surgical Outcome in Endoscopic Dacryocystorhinostomy with and without Silicon Stent Placement

    Directory of Open Access Journals (Sweden)

    Hardik Shah

    2013-02-01

    Full Text Available Objective: The purpose of this study was to compare the long term surgical outcome in endonasal dacrycystorhinostomy (DCR with and without silicon stent placement. Subjects and method: A retrospective comparative analysis of 129 patients who underwent primary endoscopic DCR with stenting (group A or without stenting (group B was done. Success was defined as grade 0 or grade 1 epiphora at minimum 6 months follow up and complete patency of the lacrimal drainage system confirmed by irrigation. Patients were followed up for mean 28 weeks, (range 6 months to 2 years. Stents were usually removed at about three to six months (mean 21 weeks. Results: Out of the 129 patients, 90 underwent silicon stent placement (group A as against 39 patients in which DCR was done without stenting (group B. Out of 90 patients of group A, 84 ( 93.33% showed complete recovery of symptoms (epiphora grading 0-1 Out of 39 patients of group B 35( 92.30% showed complete recovery of symptoms at six months follow up. Patients with stent placements showed a slightly higher rate of success as compared to patients without stenting (93.33%/ 92.30%. There was however no statistical difference in the success rate between group A and group B (p- 0.8086. Conclusion: Silicon intubation of the nasolacrimal duct may not contribute to the success of endonasal DCR. Other factors such as size of the rhinostomy and presence of infection also play an important role in success of endonasal DCR. [Natl J of Med Res 2013; 3(1.000: 34-37

  17. Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

    Energy Technology Data Exchange (ETDEWEB)

    Ichihashi, Shigeo, E-mail: shigeoichihashi@yahoo.co.jp; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

    2013-06-15

    Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

  18. Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography.

    Science.gov (United States)

    Guo, Jintao; Sun, Siyu; Liu, Xiang; Wang, Sheng; Ge, Nan; Wang, Guoxin

    2016-01-01

    Background and Study Aims. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. Patients and Methods. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures. Results. Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3-21 months). No patient presented with stent migration. Conclusion. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice. PMID:27594881

  19. Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation

    Institute of Scientific and Technical Information of China (English)

    Myung Soo Kang; Do Hyun Park; Ki Du Kwon; Jeong Hoon Park; Suck-Ho Lee; Hong-Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2007-01-01

    Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. Because it is a rare entity, the treatment modality has not been fully established. We report for the first time a patient with an intrahepatic abscess due to gallbladder perforation successfully treated by endoscopic stent placement into the gallbladder who had a poor response to continuous percutaneous drainage.

  20. Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

    NARCIS (Netherlands)

    S.M. Jeurnink (Suzanne); A. Repici (Alessandro); C. Luigiano (Carmelo); N. Pagano (Nico); E.J. Kuipers (Ernst); P.D. Siersema (Peter)

    2009-01-01

    textabstractBackground: Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objectiv

  1. Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction

    DEFF Research Database (Denmark)

    Fregonese, D.; Naspetti, R.; Ferrer, S.;

    2008-01-01

    Background: Emergency surgery for malignant colon obstruction entails relatively high morbidity and mortality rates and typically necessitates a 2-step resection. These problems might be potentially mitigated by placement of a self-expanding metal stent (SEMS) as a bridge to surgery. A nitinol...

  2. Process mapping of PTA and stent placement in a university hospital interventional radiology department

    OpenAIRE

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Reinhold, Thomas; Vollnberg, Bernd; Kentenich, Max; Hamm, Bernd; Teichgräber, Ulf K

    2012-01-01

    Objective To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital’s interventional radiology department. Methods After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers ...

  3. Results of the Ticlid or Plavix Post-Stents (TOPPS) trial: do they justify the switch from ticlopidine to clopidogrel after coronary stent placement?

    Science.gov (United States)

    Berger, Peter B

    2000-01-01

    In the Ticlid or Plavix Post-Stents (TOPPS) trial, 1016 patients undergoing successful coronary stent placement were randomized to receive aspirin and either ticlopidine or clopidogrel. In this trial, the dosages and regimens of ticlopidine and clopidogrel resembled more closely those used in most catheterization laboratories than did the two previous randomized trials comparing ticlopidine and clopidogrel. The results of the TOPPS trial support the current practice of substituting ticlopidine for clopidogrel in stent patients.

  4. Results of the Ticlid or Plavix Post-Stents (TOPPS trial: do they justify the switch from ticlopidine to clopidogrel after coronary stent placement?

    Directory of Open Access Journals (Sweden)

    Berger Peter B

    2000-10-01

    Full Text Available Abstract In the Ticlid or Plavix Post-Stents (TOPPS trial, 1016 patients undergoing successful coronary stent placement were randomized to receive aspirin and either ticlopidine or clopidogrel. In this trial, the dosages and regimens of ticlopidine and clopidogrel resembled more closely those used in most catheterization laboratories than did the two previous randomized trials comparing ticlopidine and clopidogrel. The results of the TOPPS trial support the current practice of substituting ticlopidine for clopidogrel in stent patients.

  5. Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Huei-Lung; Pan, Huay-Ben; Lin, Yih-Huie; Chen, Chiung-Yu; Lai, Pin-Hong; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Kaohsiung (China); Chung, Hsiao-Min; Wu, Tung-Ho; Chou, Kang-Ju [National Yangming University, Taipei (China)

    2006-06-15

    We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients. Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patents (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis. No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates ({+-}standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%{+-}9 and 88%{+-}6,41% {+-}10 and 88%{+-}6, 30%{+-}10 and 77%{+-}10, and 12%{+-}8 and 61%{+-}13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%{+-}16 and 86%{+-}13 vs 45%{+-}15 and 73%{+-}13 at 6 months, and 25%{+-}15 and 71%{+-}17 vs 23%{+-}17 and 73%{+-}13 at 12 months ({rho} = .436 and .224), respectively. Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

  6. Frequency of Stent Placement after Ureteroscopic Lithotripsy in a University and a State Hospital

    Directory of Open Access Journals (Sweden)

    Huseyin Celik

    2016-03-01

    Full Text Available Objective: The aim of this study was to compare frequen­cy of ureteral stent placement after ureteroscopic litho­tripsy in a university and a state hospital of two different cities, which are endemic in terms of stone and often ure­terolithotripsy was performed for urolithiasis treatment. Methods: The patients who applied in to urology clinic of Inonu University Turgut Ozal Medical Center (TOMC and urology clinic of Osmaniye State Hospital (OSH between January 2014 and May 2014 were evaluated retrospec­tively. The patients who underwent ureteroscopic lithotrip­sy due to ureteral stone, were evaluated stone locations, stone sizes, grades of pelvicaliectasia and ureteral stent placement status. Results: About 92 patients were enrolled into the study from the both hospital. After the endoscopic ureteral stone treatment, Double J stent was placed in 85 patients in TOMC (92.3% and 82 patients in OSH (89.1%. Stent im­plantation rate in the university hospital was higher than the state hospital but this was not statistically significant. There was a statistically meaningful difference in mean operative time between the 2 groups. Conclusion: Double J stent placament is recently per­formed too often after the endoscopic ureteral stone treat­ment. According to our study, university hospitals have a higher rate of incidence of double j stent placement ac­cording to state hospitals. It can be reason for that, uni­versity hospitals as the last line treatment centers, more complicated cases that refer to these centers. But in this matter, prospective, multicenter and larger series studies are needed.

  7. Impact of biliary stent-related events in patients diagnosed with advanced pancreatobiliary tumours receiving palliative chemotherapy

    Science.gov (United States)

    Lamarca, Angela; Rigby, Christina; McNamara, Mairéad G; Hubner, Richard A; Valle, Juan W

    2016-01-01

    AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients. METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event. RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group). CONCLUSION: SREs are common and impact on patient’s morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs. PMID

  8. Efficacy of the New Double-Layer Stent for Unresectable Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ken Ito

    2012-01-01

    Full Text Available Background and Aims. For distal malignant biliary obstruction in cases with short life expectancy, occlusion of plastic stents (PSs does not usually occur before death, and the application of such a procedure is considered adequate from the viewpoint of cost-effectiveness. Methods and Setting. A new commercially available DLS with side holes, a conventional DLS, and, uncovered self-expanding metal stents (SEMSs were retrospectively evaluated in patients with jaundice due to unresectable distal malignant biliary obstruction. Results. A total of 64 patients received endoscopic biliary stenting (23 patients with the new DLS, 24 patients with conventional DLS, and 17 patients with uncovered SEMS from December 2002 to August 2009. Median patency time was found to be 198 days for the new DLS group and 99 days for the conventional DLS group, revealing a significant difference between devices. There was, however, no significant difference in median patency time between the new DLS and the uncovered SEMS (198 days versus 344 days. Conclusion. The new DLS is efficient and safe and may be considered the first choice for unresectable distal malignant obstruction in cases with short life expectancy.

  9. EUS-Guided Antegrade Transhepatic Placement of a Self-Expandable Metal Stent in Hepatico-Jejunal Anastomosis

    OpenAIRE

    Everson LA Artifon; Adriana Vaz Safatle-Ribeiro; Flávio Coelho Ferreira; Luiz Poli-de-Figueiredo; Samir Rasslan; Francisco Carnevale; José Pinhata Otoch; Paulo Sakai; Michel Kahaleh

    2011-01-01

    Context To demonstrate an EUS-guided biliary drainage in patient with gastrointestinal tract modified surgically. Case report An EUS guided access to the left intra hepatic duct, followed by an antegrade passage of a partially self-expandable metal stent that was removed by using an enteroscope, in one patient with hepatico-jejunal anastomosis. There were no early or delayed complications and the procedure was effective in relieving jaundice until the self-expandable metal stent was removed, ...

  10. Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant Distal Biliary Obstruction: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jinjin Li

    Full Text Available To compare the efficacy of using covered self-expandable metal stents (CSEMSs and uncovered self-expandable metal stents (UCSEMSs to treat objective jaundice caused by an unresectable malignant tumor.We performed a comprehensive electronic search from 1980 to May 2015. All randomized controlled trials comparing the use of CSEMSs and UCSEMSs to treat malignant distal biliary obstruction were included.The analysis included 1417 patients enrolled in 14 trials. We did not detect significant differences between the UCSEMS group and the CSEMS group in terms of cumulative stent patency (hazard ratio (HR 0.93, 95% confidence interval (CI 0.19-4.53; p = 0.93, I2 = 0%, patient survival (HR 0.77, 95% CI 0.05-10.87; p = 0.85, I2 = 0%, overall stent dysfunction (relative ratio (RR 0.85, M-H, random, 95% CI 0.57-1.25; p = 0.83, I2 = 63%, the overall complication rate (RR 1.26, M-H, fixed, 95% CI 0.94-1.68; p = 0.12, I2 = 0% or the change in serum bilirubin (weighted mean difference (WMD -0.13, IV fixed, 95% CI 0.56-0.3; p = 0.55, I2 = 0%. However, we did detect a significant difference in the main causes of stent dysfunction between the two groups. In particular, the CSEMS group exhibited a lower rate of tumor ingrowth (RR 0.25, M-H, random, 95% CI 0.12-0.52; p = 0.002, I2 = 40% but a higher rate of tumor overgrowth (RR 1.76, M-H, fixed, 95% CI 1.03-3.02; p = 0.04, I2 = 0%. Patients with CSEMSs also exhibited a higher migration rate (RR 9.33, M-H, fixed, 95% CI 2.54-34.24; p = 0.008, I2 = 0% and a higher rate of sludge formation (RR 2.47, M-H, fixed, 95% CI 1.36-4.50; p = 0.003, I2 = 0%.Our meta-analysis indicates that there is no significant difference in primary stent patency and stent dysfunction between CSEMSs and UCSEMSs during the period from primary stent insertion to primary stent dysfunction or patient death. However, when taking further management for occluded stents into consideration, CSEMSs is a better choice for patients with malignant biliary

  11. USE OF COVERED SELF-EXPANDABLE NITINOL STENT FOR ANASTOMOTIC BILIARY STRUCTURE MANAGEMENT AFTER LIVER TRANSPLANTATION: THE FIRST EXPERIENCE

    Directory of Open Access Journals (Sweden)

    M. N. Kornilov

    2013-01-01

    Full Text Available Aim. The aim of this study focuses on the first experience with self-expandable stents, analysis of its efficacy and safety in the treatment of anastomotic strictures after liver transplantation. Materials and methods. There’re 136 liver transplantations performed from 2004 till 2012. To correct anastomotic strictures we’ve used only the self-expandable coated nitinol stent. We performed stenting in 7 recipient. Result. In 131 liver transplant recipients incidence of biliary strictures has been 5.3%. All of 5 patients have been managed by retrograde or antegrade way. Conclusion. Our first experience demonstrate efficacy and safety of the used tecniques up to 24 months. The analysis of more long-term results is required. 

  12. Carotid angioplasty and stent placement for restenosis after endarterectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kadkhodayan, Yasha [Washington University School of Medicine, Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Moran, Christopher J.; Cross, DeWitte T. [Washington University School of Medicine, Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Washington University School of Medicine, Department of Neurological Surgery, St. Louis, MO (United States); Derdeyn, Colin P. [Washington University School of Medicine, Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Washington University School of Medicine, Department of Neurological Surgery, St. Louis, MO (United States); Washington University School of Medicine, Department of Neurology, St. Louis, MO (United States)

    2007-04-15

    Recurrent carotid stenosis following endarterectomy is a common complication, and reoperation may be associated with increased morbidity. The goal of this study was to determine the procedural safety and long-term complication rates of carotid angioplasty and stenting for recurrent stenosis. Of 248 consecutive carotid angioplasty and/or stenting procedures performed at our institution between March 1996 and November 2005, 83 procedures for recurrent stenosis following endarterectomy were performed in 75 patients (mean age 68 years; 43 men, 32 women) without cerebral protection devices. The patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and long-term complication rates were calculated. Recurrent stenosis was reduced from a mean of 80.6% to no significant stenosis in 82 of 83 procedures. The procedural stroke rate was 3 out of 83 procedures (3.6%). The procedural transient ischemic attack (TIA) rate was 2 out of 83 procedures (2.4%). Mean follow-up was 22.4 months (range 0.1 to 86.7 months) with at least 6 months follow-up for 54 of 83 procedures (65%). There were five TIAs and no strokes on follow-up (new TIAs at 25.5 and 43.4 months; recurrent TIAs at 1, 11.1, and 12 months, all with normal angiograms). The composite 30-day stroke, myocardial infarction, or death rate was 5 of 83 procedures (6.0%). In this series, angioplasty and stenting were effective in relieving stenosis secondary to recurrent carotid disease after endarterectomy, and have low rates of ischemic complications. (orig.)

  13. Transfundal stent placement for treatment of complex basilar tip aneurysm: technical note

    Science.gov (United States)

    Vasquez, Ciro; Hubbard, Molly; Jagadeesan, Bharathi Dasan; Tummala, Ramachandra Prasad

    2014-01-01

    We describe a case where a complex unruptured basilar tip aneurysm was treated with a unique method of stent-assisted coil embolization. The aneurysm was considered to have a complex anatomy since both the left posterior cerebral artery and left superior cerebellar artery originated from the dome of the aneurysm. Also, the right posterior cerebral artery was incorporated in the aneurysm neck and needed to be protected prior to coil embolization. This case describes placement of a stent across the span of the aneurysm fundus in order to preserve the two branches arising from it, and the aneurysm dome was coiled without any complication. Using modifications of existing strategies for stent-assisted coil embolization, the aneurysm was treated without any complications and all of the vessels at risk were preserved. PMID:25336546

  14. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    Science.gov (United States)

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  15. Evaluation of metal biliary stent occlusion by three dimensional contrast enhanced MDCT%金属胆道支架梗阻原因的三维增强MDCT评价

    Institute of Scientific and Technical Information of China (English)

    郭子义; 李晓光

    2014-01-01

    Objective To evaluate the usefulness of three dimensional contrast enhanced multidetector com-puted tomography (MDCT) for the assessment of causes of biliary stent occlusion. Methods Between January 2012 and March 2014, 9 patients suspected biliary stent occlusion with recurrent jaundice by unresectable malignant biliary obstruction were enrolled in the study. A total of 14 metal biliary stents were evaluated by the Maxum Intensity Projec-tion (MIP), Volume Rendor (VR), curved planar reformation (CPR). Complications of metallic stent placement for ma-lignant bile duct obstruction, including tumor ingrowth or overgrowth, viscus perforation, and stent migration were in-dividually displayed. Results MPR technique was used to display the obstruction position, with the highest ratio. When coming to the fracture position, stent migration and adjacent relationship, MIP displayed more clearly than other technique in our current 14 metal biliary stents. For stents migrations and fractures, the MPR combined MIP and VR was found to be preferred. Conclusion A technology of non-invansive diagnosis of malignant biliary stent occlusion is readilly dispayed by high resolution 3D contrast enhanced CT and beneficial to further treatment of patients.%目的:评价动态增强高分辨率三维多层CT在鉴别不同原因所致金属胆道支架梗阻的方法及价值。方法选取2012年1月至2014年3月期间因金属胆道支架置入术后黄疸复发来院行高分辨率动态增强CT检查的9例患者,共置入金属胆道支架14枚。根据多平面重建、容积再现、最大密度投影等方法,分别针对导致金属支架狭窄的原因,如肿瘤覆盖(Overgrowth)、肿瘤长入(Ingrowth)、金属支架移位(Migration)和支架断裂进行逐一显示。结果多平面重建在本组全部14枚支架出现软组织密度所致梗阻的位置,范围方面显示率最高,最大密度投影在显示支架破损位置和个数方面显

  16. Transjugular Insertion of Bare-Metal Biliary Stent for the Treatment of Distal Malignant Obstructive Jaundice Complicated by Coagulopathy

    International Nuclear Information System (INIS)

    This study was designed to investigate retrospectively the feasibility of transjugular insertion of biliary stent (TIBS) for the treatment of distal malignant obstructive jaundice complicated by coagulopathy. Between April 2005 and May 2010, six patients with distal malignant obstructive jaundice associated with coagulopathy that was unable to be corrected underwent TIBS at our institution for the palliation of jaundice. Patients’ medical record and imaging results were reviewed to obtain information about demographics, procedure details, complications, and clinical outcomes. The intrahepatic biliary tract was successfully accessed in all six patients via transjugular approach. The procedure was technically successfully in five of six patients, with a bare-metal stent implanted after traversing the biliary strictures. One procedure failed, because the guidewire could not traverse the biliary occlusion. One week after TIBS, the mean serum bilirubin in the five successful cases had decreased from 313 μmol/L (range 203.4–369.3) to 146.2 μmol/L (range 95.8–223.3) and had further decreased to 103.6 μmol/L (range 29.5–240.9) at 1 month after the procedure. No bleeding, sepsis, or other major complications were observed after the procedure. The mean survival of these five patients was 4.5 months (range 1.9–5.8). On imaging follow-up, there was no evidence of stent stenosis or migration, with 100 % primary patency. When the risks of hemorrhage from percutaneous transhepatic cholangiodrainage are high, TIBS may be an effective alternative for the treatment of distal malignant obstructive jaundice.

  17. Transjugular Insertion of Bare-Metal Biliary Stent for the Treatment of Distal Malignant Obstructive Jaundice Complicated by Coagulopathy

    Energy Technology Data Exchange (ETDEWEB)

    Tsauo Jiaywei, E-mail: 80732059@qq.com; Li Xiao, E-mail: simonlixiao@gmail.com; Li Hongcui, E-mail: lihongcui520@126.com; Wei Bo, E-mail: allyooking@tom.com; Luo Xuefeng, E-mail: luobo_913@126.com; Zhang Chunle, E-mail: sugar139000@163.com; Tang Chengwei, E-mail: 20378375@qq.com [West China Hospital of Sichuan University, Department of Gastroenterology and Hepatology (China); Wang Weiping, E-mail: irjournalclub@gmail.com [Section of Interventional Radiology, Cleveland Clinic, Imaging Institute (United States)

    2013-04-15

    This study was designed to investigate retrospectively the feasibility of transjugular insertion of biliary stent (TIBS) for the treatment of distal malignant obstructive jaundice complicated by coagulopathy. Between April 2005 and May 2010, six patients with distal malignant obstructive jaundice associated with coagulopathy that was unable to be corrected underwent TIBS at our institution for the palliation of jaundice. Patients' medical record and imaging results were reviewed to obtain information about demographics, procedure details, complications, and clinical outcomes. The intrahepatic biliary tract was successfully accessed in all six patients via transjugular approach. The procedure was technically successfully in five of six patients, with a bare-metal stent implanted after traversing the biliary strictures. One procedure failed, because the guidewire could not traverse the biliary occlusion. One week after TIBS, the mean serum bilirubin in the five successful cases had decreased from 313 {mu}mol/L (range 203.4-369.3) to 146.2 {mu}mol/L (range 95.8-223.3) and had further decreased to 103.6 {mu}mol/L (range 29.5-240.9) at 1 month after the procedure. No bleeding, sepsis, or other major complications were observed after the procedure. The mean survival of these five patients was 4.5 months (range 1.9-5.8). On imaging follow-up, there was no evidence of stent stenosis or migration, with 100 % primary patency. When the risks of hemorrhage from percutaneous transhepatic cholangiodrainage are high, TIBS may be an effective alternative for the treatment of distal malignant obstructive jaundice.

  18. Biliary leaks after laparoscopic cholecystectomy:timetostentortimetodrain

    Institute of Scientific and Technical Information of China (English)

    Haim Pinkas; Patrick G. Brady

    2008-01-01

    BACKGROUND: Endoscopic retrograde cholangiopan-creatography (ERCP) with placement of a biliary stent or nasobiliary (NB) drain is the procedure of choice for treatment of post-cholecystectomy bile duct leaks. The aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal, length of hospital stay and number of required endoscopic procedures. METHODS: Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct leak. Ten patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was observed. Ten patients were treated with internal biliary stents. Biliary sphincterotomies were performed for stone extraction or a presumed papillary stenosis. Large bilomas were drained percutaneously prior to stenting. RESULTS: In all 20 patients, a cholangiogram and successful placement of a NB drain or internal stent was achieved. Four patients (20%) were found to have bile duct stones, which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary instrumentation. Fifteen cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to ERCP. Closure of the leak was documented within 2 to 11 days (mean 4.7±0.9 days) in patients receiving a NB drain. The drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days (mean 29.1±4.4 days). The stent was then removed endoscopically after documentation of leak closure. Bile leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain, resulting in fewer ERCPs required for treatment of biliary leaks. Internal biliary stents were in place longer owing

  19. 联合应用胆道支架与十二指肠支架植入术治疗恶性胆管梗阻合并十二指肠梗阻%Combined stent insertion in the treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    李陆鹏; 于友涛; 张晶岩; 何东风

    2011-01-01

    Objective To evaluate the effect of biliary and duodenal stent insertion in the palliation of malignant biliary and duodenal obstruction. Methods Eighteen patients of malignant biliary and duodenal obstruction underwent biliary and duodenal self-expandable metal stent placement. Malignancies included 12 pancreatic tumors, 3 biliary tumors, 2 duodenal tumors and 1 metastatic lymphoma. All the patients had image evidence of biliary obstruction and duodenal obstruction. In 14 patients, biliary obstruction occurred before the onset of duodenal obstruction. In the other 4 patients, biliary obstruction occurred concurrently with duodenal obstruction. All patients underwent first metallic biliary stent placement, and then trans-oral the duodenal stent insertion. Results Combined metal stenting was successfully placed in all 18 patients. Effective palliation of biliary obstruction was achieved in all 18 cases, evidenced by the decrease in the level of total bilirubin after stenting. One patient died of aspiration 5 days after placement of duodenal stent. No severe complications occurred in other patients. Seventeen patients had good clinical outcome, with relief of obstructive symptoms. Survival time of them was 3-17 months with a median value of 8. 6 months. Conclusion Combined metal stenting is safe and effective for malignant biliary and duodenal obstruction.%目的 评价联合应用胆道支架与十二指肠支架植入术治疗恶性梗阻性黄疸合并十二指肠梗阻的疗效.方法 18例恶性梗阻性黄疸合并十二指肠梗阻患者接受双管腔内支架植入术,其中胰腺癌12例,胆管癌3例,十二指肠癌2例,腹腔淋巴结转移1例.14例患者首先出现胆管梗阻症状,然后出现十二指肠梗阻症状;4例患者同时表现为胆管及十二指肠梗阻症状.对所有患者均先行经皮肝穿刺植入胆管支架解决胆管梗阻,再经口植入十二指肠支架治疗十二指肠梗阻.结果 18例患者均成功植入胆道及

  20. The operative cooperation and nursing in performing airway stent placement under DSA guidance for treating airway stenosis

    International Nuclear Information System (INIS)

    Objective: To discuss the key points of the nursing care for effectively performing airway stent placement under DSA monitoring for airway stenosis. Methods: Corresponding nursing care measures were carried out for 118 patients with airway stenosis who were treated with airway stent placement. Results: The symptom of dyspnea was markedly relieved after stent implantation in all 118 patients with airway stenosis. Conclusion: To strengthen the preoperative psychological nursing and operative posture training, to make close postoperative watch on vital signs, to adopt some prevention measures for possible complications and to give necessary medical advises at the time of discharge are very helpful for patient's recovery after the surgery. (authors)

  1. Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis

    Institute of Scientific and Technical Information of China (English)

    Hong Shan; Xiang-Sheng Xiao; Ming-Sheng Huang; Qiang Ouyang; Zai-Bo Jiang

    2005-01-01

    AIM: To evaluate the value of endovascular stent in the treatment of portal hypertension caused by benign main portal vein stenosis.METHODS: Portal vein stents were implanted in six patients with benign main portal vein stenosis (inflammatory stenosis in three cases, postprocedure of liver transplantation in another three cases). Changes in portal vein pressure, portal vein patency, relative clinical symptoms, complications, and survival were evaluated.RESULTS: Six metallic stents were successfully placed across the portal vein stenotic or obstructive lesions in six patients. Mean portal venous pressure decreased significantly after stent implantation from (37.3±4.7) cm H2O to (18.0±1.9) cm H2O. The portal blood flow restoredand the symptoms caused by portal hypertension were eliminated. There were no severe procedure-related complications. The patients were followed up for 1-48 mo. The portal vein remained patent during follow-up. All patients survived except for one patient who died of other complications of liver transplantation. CONCLUSION: Percutaneous portal vein stent placement for the treatment of portal hypertension caused by benign main portal vein stenosis is safe and effective.

  2. [Appropriate Biliary Drainage Methods for Unresectable Cholangiocarcinomas].

    Science.gov (United States)

    Oishi, Tatsurou; Kanemoto, Yoshiaki; Yoshioka, Yuuta; Sawada, Ryuuichirou; Sekine, Sachi; Miyanaga, Hiroto; Sakahira, Hideki; Takahashi, Hironori; Miyamoto, Katsufumi; Koyama, Takashi

    2015-11-01

    We investigated the efficacy of different biliary drainage methods for the treatment of unresectable cholangiocarcinomas. We performed a retrospective study of 28 patients with unresectable cholangiocarcinomas who underwent biliary drainage at our hospital between January 2008 and June 2014 to compare the incidence of post-drainage stent dysfunction (SD) and reintervention (RI) for SD according to primary drainage method, lesion site, and complication status (the presence or absence of cholangitis). The duration of stent patency was compared between the different stent types. No significant differences in the incidence of SD and RI were found according to primary drainage methods, lesion site, or the presence or absence of cholangitis. The mean durations of stent patency for plastic and metal stents were 2.7 months and 7.4 months, respectively, suggesting that metal stents should be selected when the estimated prognosis is ≥2 months. Furthermore, metal stent placement, rather than the additional placement of plastic stents, should be considered a feasible option in cases of SD. PMID:26805093

  3. Fundamental study of the influence of various biliary metallic stents for irradiation. Dose perturbation at the interface of metallic stents measured by TL sheets

    International Nuclear Information System (INIS)

    To evaluate the effects of radiation on various types of EMS (expandable metallic stent) that differ in shape and the quality of the material, we performed external irradiation and intraluminal irradiation using 5 types (Spiral Z stent: SZ, Wallstent: Wall, NT stent: NT, ZA stent: ZA, Accuflex: Acc.) of EMS for the biliary tract, and measured back scatter on the EMS interface and absorption due to shielding using TL (thermoluminescent) sheets. TL sheets can be wound around the external side of the EMS in water, allowing phantom experiments close to the in vivo state for the measurement of dose perturbation of radiation near the EMS. Images of the relative dose in a small area near the EMS were obtained using a spatial read-out system using a cooled CCD camera. In external irradiation, an 8.2±0.53% increase in back scatter was observed in SZ with a wire diameter of 260 μm and 7.9±1.2% and 4.5±0.62% decreases in absorption due to shielding in SZ and Wall, respectively. In intraluminal irradiation, a 7.7±0.85% decrease in absorption was observed in SZ alone. Therefore, in both external and intraluminal irradiation on various types of EMS that differ in shape and the quality of the material, the dose perturbation near the EMS is 8.2% or less, which presents no clinical problem. (author)

  4. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography.

    Science.gov (United States)

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

    2016-02-10

    Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents. PMID:26862364

  5. Endoscopic stent treatment of elderly patients with advanced malignant biliary obstructive jaundice%内镜下支架置入治疗老年晚期恶性胆管梗阻性黄疸的临床观察

    Institute of Scientific and Technical Information of China (English)

    窦炜; 宋秋花

    2011-01-01

    目的 观察内镜下胆管内支架置入对老年晚期恶性梗阻性黄疸的引流效果.方法 回顾分析36例老年晚期恶性梗阻性黄疸患者的临床资料.结果 胆管内支架置入对老年恶性梗阻性黄疸患者有明显的短期减黄效果,且住院时间短,近期并发症少,但远期由于支架堵塞,有引起黄疸复发及胆管炎危险.结论 胆管内支架置入是一种安全有效的治疗老年晚期恶性胆管梗阻性黄疸的减黄方法,对于失去手术机会的晚期恶性胆管梗阻患者,在延长患者生存期,提高生活质量方面均具有十分重要的意义.%[ Objective ] To observe the endoscopic biliary stent placement for elderly patients with advanced malignant obstructive jaundice drainage effect. [ Methods ] 36 cases of elderly patients with advanced malignant obstructive jaundice in patients with clinical data were retrospectively analyzed. [ Results ] Biliary stenting in elderly patients with malignant obstructive jaundice had obvious short-term effect of reducing yellow, and the hospitalization time was short, the recent few complications, but the long-term due to stent blockage, there was cause jaundice risk of recurrence and cholangitis. [Conclusion] The biliary stent is a safe and effective treatment for elderly patients with advanced malignant biliary obstructive jaundice yellow reduction method, for the losa of opportunities for surgery in patients with advanced malignant biliary obstruction, In the extended survival period, to improve the quality of life isof great significance.

  6. Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter

    Directory of Open Access Journals (Sweden)

    Carroll Daniel

    2010-01-01

    Full Text Available Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions. In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions. Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.

  7. Characterization of compression behaviors of fully covered biodegradable polydioxanone biliary stent for human body: A numerical approach by finite element model.

    Science.gov (United States)

    Liu, Yanhui; Zhang, Peihua

    2016-09-01

    This paper presents a study of the compression behaviors of fully covered biodegradable polydioxanone biliary stents (FCBPBs) developed for human body by finite element method. To investigate the relationship between the compression force and structure parameter (monofilament diameter and braid-pin number), nine numerical models based on actual biliary stent were established, the simulation and experimental results are in good agreement with each other when calculating the compression force derived from both experiment and simulation results, indicating that the simulation results can be provided a useful reference to the investigation of biliary stents. The stress distribution on FCBPBSs was studied to optimize the structure of FCBPBSs. In addition, the plastic dissipation analysis and plastic strain of FCBPBSs were obtained via the compression simulation, revealing the structure parameter effect on the tolerance. PMID:27183432

  8. Endoscopic management of hilar biliary strictures.

    Science.gov (United States)

    Singh, Rajiv Ranjan; Singh, Virendra

    2015-07-10

    Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345

  9. Endoscopic management of biliary leaks after laparoscopic cholecystectomy.

    Science.gov (United States)

    Rustagi, Tarun; Aslanian, Harry R

    2014-09-01

    Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic cholelithiasis. Although it has distinct advantages over open cholecystectomy, bile leak is more common. Endoscopic retrograde cholangiopancreatography is the diagnostic and therapeutic modality of choice for management of postcholecystectomy bile leaks and has a high success rate with the placement of plastic biliary stents. Repeat endoscopic retrograde cholangiopancreatography with placement of multiple plastic stents, a covered metal stent, or possibly cyanoacrylate therapy may be effective in refractory cases. This review will discuss the indications, efficacy, and complications of endoscopic therapy.

  10. Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula

    Directory of Open Access Journals (Sweden)

    Iskender Özcan

    2008-01-01

    Full Text Available Abstract Background Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF is difficult to treat with standard endoscopic techniques. Case presentation We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach. Conclusion Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

  11. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography

    OpenAIRE

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

    2016-01-01

    Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered l...

  12. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    Energy Technology Data Exchange (ETDEWEB)

    Idoguchi, Koji, E-mail: idoguchi@ares.eonet.ne.jp; Yamaguchi, Masato; Okada, Takuya [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Nomura, Yoshikatsu [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimura, Kazuro [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Okita, Yutaka [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan)

    2012-10-15

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with 'kissing'-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  13. Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk, E-mail: hongsukpark@gmail.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Do, Young Soo, E-mail: ysdo@skku.edu [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Park, Kwang Bo, E-mail: kbjh.park@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Kim, Duk-Kyung, E-mail: dukkyung.kim@samsung.com [Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, Sung Wook, E-mail: sw.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Shin, Sung Wook, E-mail: sw88.shin@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Cho, Sung Ki, E-mail: sungkismc@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Hyun, Dongho, E-mail: mesentery.hyun@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, In Wook, E-mail: inwook.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of)

    2013-11-01

    Purpose: To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up. Materials and methods: We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries. Results: Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery. Conclusion: Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure.

  14. Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

    International Nuclear Information System (INIS)

    Purpose: To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up. Materials and methods: We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries. Results: Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery. Conclusion: Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure

  15. Nintinol Self-Expandable Metallic Stenting in Management of Malignant Obstructive Jaundice: A Case Series

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Abedini

    2010-01-01

    Full Text Available Background and Aims: Palliation therapy is the only available therapeutic method for most patients with tumor-induced obstructive jaundice. Metallic stents are now performed percutaneously as an alternative route to the endoscopic approach. It is widely accepted because of its safety, good patency rate, and minimal invasiveness. This study was designed to evaluate the long-term results of metallic self-expandable stent insertion in patients with malignant stenosis of the biliary tree.Methods: It is a longitudinal study of patients with percutaneously biliary stenting from September 2005 to March 2009. The patients had unresectable malignant biliary obstruction with unsuccessful endoscopic stenting and access. Percutaneous transhepatic cholangiogram performed after adequate local anesthesia, under sonographic or fluoroscopic guidance. Stenting or balloon dilation was performed through the hydrophilic guide wire. Among 50 patients, 45 stents were placed in biliary tree stenosis sites. Patients' follow-up was during the first, second, third, and then the sixth month after insertion of biliary stents. Stent patency was considered successful in our patients, when there were no lab results or sonographic appearance of biliary tree obstruction.Results: 10(20% patients' stent placement treatment failed because of unsuccessful technical procedure. The stenosis of biliary tract was complete and passage of guide wire was not possible through the tumor growth. 6 (15 % patients with successful stent placements died within one month (mean, 22 days. Total serum bilirubin resolved to below 1.5 mg/dl within 30 days for 36 (90% patients with successful stent placements. Early complications not leading to death occurred in 28% of cases. The mean survival time for all patients who underwent stent placement was 140 days (16-420days. The mean patency rate for all stents was 147 days.Conclusions: Percutaneous biliary stenting is a safe procedure with few technical

  16. 胆道金属支架在治疗胆道恶性梗阻疾病中的临床应用%Clinical Application of Biliary Metal Stents in the Treatment of Malignant Biliary Obstruction

    Institute of Scientific and Technical Information of China (English)

    崔建华

    2015-01-01

    目的:探讨胆道金属支架在治疗胆道恶性梗阻疾病中的临床应用。方法整群选取2012年2月—2015年3月该院收治的64例胆道恶性梗阻患者,根据置入方法分为内镜下逆行胰胆管造影术(ERCP组33例)与经皮经肝胆管引流术(PTCD组31例),观察比较两组相关指标。结果两组手术总成功率比较差异无统计学意义(P>0.05)。两组比较术后并发症总发生差异有统计学意义(P<0.05);ERCP组低位恶性梗阻疾病术后并发症发生率明显低于PTCD组,比较差异有统计学意义(P<0.05);ERCP组高位恶性梗阻疾病术后并发症发生率明显高于PTCD组,比较差异有统计学意义(P<0.05)。 ERCP组、PTCD组黄疸改善情况比较差异无统计学意义(P>0.05);ERCP组低位恶性梗阻疾病黄疸改善百分比明显高于PTCD组比较差异有统计学意义(P<0.05);ERCP组高位恶性梗阻疾病黄疸改善百分比明显低于PTCD组比较差异有统计学意义(P<0.05)。结论ERCP更为适用于低位恶性梗阻患者,PTCD则更为适用于高位恶性梗阻患者。%Objective To study the effect of biliary metal stents applied to the treatment of malignant biliary obstruction. Methods 64 patients with malignant biliary obstruction admitted in our hospital from February 2012 to March 2015 were selected and divided into ERCP group (33 cases) and PTCD group (31 cases) in accordance with the placement method of biliary metal stents. The ERCP group were treated by ERCP, while the PTCD group were treated by PTCD. And the related indicators of the two groups were observed and compared. Results The difference in the surgical success rate between the two groups was not statistically significant(P>0.05). A statistically significant difference was found in the overall incidence of postoperative complications between the two groups (P0.05). The proportion of low-level malignant obstruction patients with

  17. 经皮胆道支架置入术的超声引导置管的临床研究%The Clinical Study on PTBD Guided by Ultrasound in the Patients treated with Metallic Biliary Stent

    Institute of Scientific and Technical Information of China (English)

    石力; 汤礼军; 汪涛; 陈涛; 陈琪; 罗皓

    2012-01-01

      Objective To explore the method of percutanoues transhepatic biliarry drainage(PTBD) guided by ultrasound in the patients treated with metallic stent placement. Methods The clinic data of 51 patients treated with metallic biliary stent were analyzed. Results Catheters were placed into the right bile duct in 29 patients, and into the left bile duct in 10 patients. Catheters were placed into both of the right and the left bile duct in 12 patients. Metallic stent were successfully inserted in 46 patients, and the successful rate was 90.2 percent. Successful rate of stent placement through right and left bile duct were 94.7 percent and 53.9 percent, and the procedure time of stent placement were (32.8±12.4) and (46.2±11.3) minutes respectively. Conclusion The second and the third grade of right biliary duct are the ideal position to be punctured. It is beneficial for metallic stent placement to insert catheters in both right and left biliary duct simultaneously.%  目的对经皮胆道支架的超声引导置管方法进行探讨.方法对51例接受经皮胆道支架置放术的患者的临床资料进行分析.结果单独穿刺右前支胆管29例,单独穿刺左外支胆管10例,左右胆管同时置管12例.胆道支架置放成功46例,成功率90.2%.经右侧胆管放置40例,成功38例,其中2例为先经左侧胆管放置失败后再经右侧胆管放置成功;经左侧胆管放置14例,成功8例,其中1例为先经右侧胆管放置失败后再经左侧胆管放置成功者.一次性经右侧及左侧放置支架成功率分别94.7%和53.9%,二者相比差异显著(P<0.01);所用时间(分钟)分别为(32.8±12.4)及(46.2±11.3),二者相比差异显著(P<0.01).结论右肝二、三级胆管应该为穿刺置管的首选,左右胆管同时置管可提高支架放置成功率.

  18. Metal stent and endoluminal high-dose rate 192iridium brachytherapy in palliative treatment of malignant biliary tract obstruction

    International Nuclear Information System (INIS)

    Since December 1989, 9 patients with inoperable malignant biliary tract obstruction were treated palliatively by a combined modality treatment consisting of placement of a permanent biliary endoprosthesis followed by intraluminal high dose-rate 192Ir brachytherapy. A dose of 10 Gy was delivered in a hyperfractionated schedule at the point of reference in a distance of 7.5 mm of centre of the source. External small field radiotherapy (50.4 Gy, 1.8 Gy per day, 5 fractions per week) was also given in six cases (M/O, Karnofsky >60%). In 9/9 cases an unrestrained bile flow and an interruption of pruritus was achieved, in 78% (7/9) of cases the duration of palliation was as long as the survival time (median survival time 7.5 months). (orig.)

  19. Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization

    Science.gov (United States)

    Di, Xiao; Ji, Dong-Hua; Chen, Yu; Liu, Chang-Wei; Liu, Bao; Yang, Juan

    2016-01-01

    Abstract Background: Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention. Methods: This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA. Results: A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ2 test, P = 0.034). Conclusion: Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA. PMID:27583854

  20. Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques.

    Science.gov (United States)

    Moon, Jong Ho; Rerknimitr, Rungsun; Kogure, Hirofumi; Nakai, Yousuke; Isayama, Hiroyuki

    2015-09-01

    Endoscopic management of unresectable hilar malignant biliary stricture (MBS) is currently challenging, and the best approach is still controversial. Liver volume is the key to adequate biliary drainage in hilar MBS and multiple stenting is mandatory to drain over 50% of liver volume in most cases. The self-expandable metallic stent (SEMS) has shown superior patency to plastic stents in recent reports. There are two methods of multiple stenting for hilar MBS: stent-in-stent (SIS) and side-by-side (SBS). Advantages of SIS include multiple SEMS placement in one stent caliber at the common bile duct (CBD), which is considered physiologically ideal. The through-the-mesh (TTM) technique with guidewires and the SEMS delivery system can be technically difficult in SIS, although the recent development of dedicated SEMSs having a loose portion facilitating the TTM technique makes SIS technically feasible both at stent deployment and re-interventions. Conversely, the SBS technique, if placed across the papilla, is technically simple at initial placement and re-intervention at stent occlusion. However, SBS has potential disadvantages of overexpansion of the CBD because of parallel placement of multiple SEMS, which can lead to portal vein thrombosis. Given the limited evidence available, a well-designed randomized controlled trial comparing these two techniques is warranted. PMID:26136361

  1. Symptomatic stent cast.

    LENUS (Irish Health Repository)

    Keohane, John

    2012-02-03

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  2. Symptomatic stent cast.

    Science.gov (United States)

    Keohane, John; Moore, Michael; O'Mahony, Seamus; Crosbie, Orla

    2008-02-01

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  3. 全覆膜金属胆道支架治疗良性胆管狭窄的临床疗效%Clinical effectiveness of fully covered expandable metal stent in benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    张迎春; 麻树人; 杨卓; 赵志峰; 高飞; 高峰; 韩笑; 刘宝军; 栗彤

    2014-01-01

    目的 评价全覆膜金属胆道支架在治疗良性胆管狭窄中的应用价值.方法 回顾性总结53例行内镜下置入全覆膜金属胆道支架治疗的良性胆管狭窄患者的临床资料,分析支架置入和取出情况、疗效和并发症发生情况.结果 53例均一次性成功置入全覆膜金属胆道支架.支架放置时间2~186 d,平均放置时间138 d.支架取出后随访6个月,胆管狭窄均得到缓解,短期有效率为100.0%;继续随访12个月,6例再发胆管狭窄,其余47例胆管狭窄长期缓解,长期有效率为88.7%(47/53).出现术后胰腺炎1例、支架移位3例、胆管炎5例、高淀粉酶血症9例、胆泥33例,无一例出血、穿孔发生.结论 全覆膜金属胆道支架治疗良性胆管狭窄是安全、有效的,大多数患者临床症状可以得到长期缓解.%Objective To evaluate the clinical effectiveness of fully covered metal stent(FCMT) for patients with benign biliary stricture(BBS).Methods The clinical data of 53 patients with benign biliary strictures who were treated with placement of FCMT were retrospectively analyzed.Results All FCMT were successfully placed in 53 patients and removed after a mean time of stent placement of 138 d(ranging 2-186 d).Biliary stricture was resolved in all patients upon the follow-up at 6 months after stent removal with the efficiency rate being 100%.Upon follow-up at 12 months after stent removal,biliary stricture relapsed in 6 patients,achieving a stricture resolution rate of 47/53 (88.7%).Postoperative complication included pancreatitis (n =1),stent migration (n =3),cholangitis (n =5),hyperamylasemia(n =9) and biliary sludge (n =33).No hemorrhage or perforation was observed.Conclusion The use of FCMS for BBS is safe and leads to long-term clinical resolution.

  4. Percutaneous management of tumoral biliary obstruction in children

    International Nuclear Information System (INIS)

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  5. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  6. Biliary metal stent combined with pancreatic stent in patients with periampullary carcinoma by painless endoscopy%无痛内镜下胆道金属支架联合胰管支架治疗壶腹周围癌

    Institute of Scientific and Technical Information of China (English)

    肖亿; 潘光栋

    2013-01-01

    Objective To evaluate the clinical efficacy of biliary metal stent combined with pancreatic stent for patients of periampullary carcinoma.Methods Three patients were diagnosed as periampullary carcinoma pathologically or clinically,including 1 duodenal adenocarcinoma pathologically,2 pancreas head cancer clinically.Imaging finding was strictures both in pancreatic and biliary ducts.Pancreatic stent was firstly implanted through endoscopy to the narrowed pancreatic ducts,inflatable biliary metal stent were then implanted to the biliary tract.Serum levels of bilirubin,amylase in serum and urine and the clinical manifestations were observed before and after operation.Results Three patients were treated successfully with biliary metal stent and pancreatic stent.Compared with that of before operation,serum levels of bilirubin,amylase in serum and urine and the clinical manifestations were lower postoperation.Conclusion The combined implacement of biliary metal stent and pancreatic stent is safe and effective in relieving malignant obstruction in periampullary carcinoma.%目的 探讨胆道金属支架联合胰管支架置入治疗壶腹周围癌的临床价值.方法 3例患者经临床或病理诊断为壶腹周围癌,其中1例经病理学诊断为(十二指肠乳头)腺癌,2例临床诊断为胰头癌.影像学表现为胰管和胆管均有狭窄,经内镜先在胰管内置入塑料胰管支架,后胆道内置入可膨胀式金属支架,观察支架置放前后患者的临床表现及胆红素、血尿淀粉酶等生化指标变化.结果 3例均顺利置入胆道金属支架及胰管支架,支架置放后总胆红素、血尿淀粉酶均有明显的下降,症状缓解.结论 胆道金属支架联合胰管支架可以解除壶腹周围癌患者的胆、胰管恶性狭窄与梗阻,安全有效.

  7. Endovascular stent-graft placement and secondary intervention for abdominal aortic aneurysm in a patient who had a previously inserted iliac stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-04-15

    Endovascular repair of abdominal aortic aneurysm is associated with low morbidity and mortality rates when compared to open surgery, and this can be used in patients who are at a high risk for open surgical repair. Also, secondary intervention is an important for achieving intermediate and long term success of endovascular repair of abdominal aortic aneurysm as this can resolve complications. We report here on endovascular stent-graft placement and a secondary interventional procedure in the abdominal aortic aneurysm of a patient who had a previously inserted iliac stent.

  8. The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice

  9. Malignant biliary obstruction: treatment with interventional radiology

    Institute of Scientific and Technical Information of China (English)

    翟仁友; 钱晓军; 戴定可; 于平

    2003-01-01

    Objective To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction. Methods From January 1995 to Febuary 2001, 243 consecutive patients (161 men and 82 women; aged 26-91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.Results One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1-2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage,20 patients had two stents installed from top to bottom to create stenting of adequate ength, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8,P<0.001) with an average patency of 9.7 months(log rank 4.7,P<0.05).Conclusion Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may

  10. Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents.

    OpenAIRE

    Deviere, J; M Cremer; Baize, M; Love, J; Sugai, B; Vandermeeren, A

    1994-01-01

    Twenty patients with chronic pancreatitis and signs of biliary obstruction were treated by endoscopic placement of self expandable metal mesh stents, and followed up prospectively. Eleven had been treated previously with plastic endoprostheses. All had persistent cholestasis, seven patients had jaundice, and three overt cholangitis. Endoscopic stent placement was successful in all cases. No early clinical complication was seen and cholestasis, jaundice or cholangitis rapidly resolved in all p...

  11. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Yohei Kawatani

    2016-01-01

    Full Text Available Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN. This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8% developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P=0.017 and P=0.032, resp.. Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P=0.018, and 95% CI = 1.46–59.7. Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement.

  12. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    International Nuclear Information System (INIS)

    Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN). This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8%) developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P = 0.017 and P = 0.032, resp.). Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P = 0.018, and 95% CI = 1.46–59.7). Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement

  13. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  14. Argon Plasma Coagulation Combined with Covered Stent Placement for Management of Tracheobronchial Stenoses/occlusions as well as Esophagorespiratory Fistulas

    Directory of Open Access Journals (Sweden)

    Hongwu WANG

    2010-09-01

    Full Text Available Background and objective It is a complex problem and difficult treatment for tracheobronchial stenoses/occlusions involving in carina. The aim of this study is to investigate the feasibility and efficiency of argon plasma coagulation (APC and bifurcated covered Z-type stents (CZTS placement for the treatment of tracheobronchus stenoses and esophagorespiratory fistula (ERF. Methods Thirty-two cases with airway disorders were retrospectively reviewed for the treatment of APC and CZTS placement. Under the bronchoscopic guidance, APC was first given in patients with airway stenoses, then CZTS was placed under the fluoroscopic and flexible bronchoscopic guidance either with airway stenoses or ERF. Results APC was first given in 19 patients with airway stenoses. Airway structures were significantly improved after APC procedure (57.4%-72.1% before APC vs 12.8%-25.8% after APC. Thirty-two CZTS were technically successfully placed in 30 out of 32 cases involving in carinal bifurcation. After APC and stent placement, short breath index was significantly reduced and karnofsky physical score (KPS increased obviously. The endobronchial defects were successfully palliated with bifurcated CZTS placed under fluoroscopy and flexible bronchoscopy in 12 out of 13 patients with ERFs. There is no bleeding introprocedure. Mucous retention was very common in all types of the stents less than 2 weeks after stenting, which required debridement by bronchoscopy and could be prevented by normal saline solution nebulizations. Granuloma developed at the ends of stents after 1 month of stenting which all of them were treated successfully with APC and CO2 cryosurgery. Conclusion Utilization of APC and retrieval bifurcated CZTS placement is a simple and safe protocol for the management of airway complex stenoses involving the tracheal carina and ERF.

  15. Use of a partially covered self-expandable metallic stent to treat a biliary stricture secondary to chronic pancreatitis complicated by recurrent cholangitis: a case report.

    Science.gov (United States)

    Okabe, Yoshinobu; Ishida, Yusuke; Sasaki, Yu; Ushijima, Tomoyuki; Sugiyama, Gen; Tsuruta, Osamu

    2012-05-01

    The patient was a 69 year old man who had been diagnosed with alcoholic chronic pancreatitis and lower common bile duct (CBD) stricture. He subsequently developed cholangitis 2-3 times a year, and we replaced the endoscopic biliary stent (EBS) each time. In April 2010, he was admitted because of complication by a liver abscess and acute cholangitis. We performed percutaneous transhepatic liver abscess drainage. The inflammatory findings then rapidly improved, but the patient developed acute cholangitis due to the sludge and the stones. Then, we placed a partially covered self-expandable metallic stent (C-SEMS) in the lower CBD and performed endoscopic lithotripsy through the C-SEMS, and the cholangitis subsequently improved. Two weeks after, we removed the C-SEMS endoscopically and replaced it with a 10 Fr plastic stent; since then there have been no recurrences of cholangitis. Our experience in this case suggested that when a plastic stent is placed long-term to treat a biliary stricture associated with chronic pancreatitis, it might be useful to also control biliary sludge and stones using a C-SEMS. PMID:22533753

  16. Use of fully covered self-expanding metal stents for the management of benign biliary conditions Utilización de prótesis metálicas autoexpandibles totalmente recubiertas en procesos biliares benignos

    OpenAIRE

    García-Cano, J; L. Taberna Arana; C. Jimeno Ayllón; R. Martínez Fernández; L. Serrano Sánchez; A.K. Reyes Guevara; M. Viñuelas Chicano; C. J. Gómez Ruiz; M. J. Morillas Ariño; J. I. Pérez García; G. Pérez Vigara; A Pérez Sola

    2010-01-01

    Background and aim: biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct. Patients and methods: in a prospective study, stents o...

  17. Long-Term Outcome of Self Expandable Metal Stents for Biliary Obstruction in Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Alexander Waldthaler

    2013-01-01

    Full Text Available Context Insertion of a self-expandable metal stent is still controversial for treatment of benign common bile duct stenosis but can be a valuable alternative to surgical treatment. Objective Aim of our study was to analyze the efficacy of covered and uncovered selfexpandable metal stent in patients with chronic pancreatitis and common bile duct stenosis. Material and methods Twenty patients with common bile duct stenosis due to alcoholic chronic pancreatitis were retrospective analyzed. All patients had advanced chronic pancreatitis, presenting with calcifications in pancreatic head. Uncovered self-expandable metal stent (uSEMS were used in 11 patients (3 females, 8 males while in 9 patients (3 females, 6 males partially covered self-expandable metal stent (cSEMS were inserted. All patients treated with self-expandable metal stent had contraindications for surgery. Results Overall mean follow up time was 155 weeks: 206 (52-412 weeks in uSEMS, and 93 (25-233 weeks in cSEMS, respectively. Stent patency was in mean 118 weeks: 159 (44-412 weeks in uSEMS and 67 (25-150 weeks in cSEMS (P=0.019. In the uSEMS group, reintervention was necessary in 5 patients (45% due to stent obstruction, whereas in the cSEMS group 4 patients (44% needed reintervention (2 obstructions, 2 migration. Stent migration is an early complication, compared to obstruction (P<0.05, and in cSEMS obstruction occurred significantly earlier compared to uSEMS (P<0.05. Conclusion Patency of uSEMS was significantly longer compared to partially cSEMS. Available self-expandable metal stent, unfortunately, do not meet the demands on successful treatment of benign common bile duct stenosis.

  18. A study of impact of stent implantation in distal common bile duct on duodenal-biliary reflux%胆总管末端植入金属支架对肠胆反流的影响

    Institute of Scientific and Technical Information of China (English)

    温锋; 卢再鸣; 郭启勇; 杨晓珍; 毛晓楠; 梁宏元

    2010-01-01

    目的 探讨胆总管末端植入金属支架后早期肠胆反流状况和反流性胆管炎的发生机制.方法 16例无胆系感染并排除肠梗阻及肠道、胆道手术病史的恶性低位胆管梗阻患者,通过经皮经肝胆管穿刺及单纯外引流后,于胆总管末端植入金属网状支架.在植入支架前进行血白细胞计数、中性粒细胞百分比和总胆红素、直接胆红素含量的检测.支架植入后2~5 d再次检查上述各项指标,并于拔管前2 h口服含有99锝m-二乙三氨五醋酸(99Tcm-DTPA)的水,2 h后检测胆汁中核素的放射性活度.对研究获得的计量资料,采用配对t检验或秩和检验,P<0.05为差异有统计学意义.结果 支架植入后2~5 d,14例进行了胆汁99Tcm检测,其中12例于拔管前2 h胆汁中检测到99Tcm活度,放射计数占总摄入剂量的1.82%.2例胆汁中未检测到99Tcm.14例进行胆汁核素检测的患者均没有出现高热、寒战、黄疸加重的胆管炎表现,血白细胞计数和中性粒细胞百分比分别为(7.59±2.62)×109/L、0.74,与支架植入前的(7.94±3.84)×109/L和0.68相比,差异均没有统计学意义(分别为t=0.423、Z=1.036,P值均>0.05);而血总胆红素和直接胆红素值的中位数分别为92.2和74.3 μmol/L,明显低于支架植入前的202.6和154.7 μmol/L,差异均具有统计学意义(Z值均为-3.170,P值均<0.05).结论 胆总管末端植入支架后,早期就有较高的肠胆反流发生率,但没有反流性胆管炎的发生.%Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte

  19. 经内镜置支架治疗晚期恶性梗阻性黄疸%Stent placement via endoscopy for advanced malignant obstructive jaundice

    Institute of Scientific and Technical Information of China (English)

    侯森林; 乔占英; 康建省; 乔娜; 张立超; 韩锦胜

    2012-01-01

    目的 探讨应用经内镜置支架治疗晚期恶性梗阻性黄疸的临床疗效及预后.方法 回顾分析该科2003年6月~2011年6月292例经内镜置支架治疗晚期恶性梗阻性黄疸患者,对其成功率、并发症发生率、临床疗效和预后等进行分析.结果 行经内镜逆行胰胆管造影(ERCP)操作成功率96.23%(281/292),术后1周复查血清生化指标,总胆红素、直接胆红素、谷丙转氨酶与谷草转氨酶均下降明显(P<0.05).并发症主要是感染、出血、胰腺炎,并发症发生率为7.88%(23/292),经治疗后症状消失,没有操作相关的死亡发生,全组生存期为(7.21±4.68)个月,中位生存时间为7.3个月.结论 经内镜置支架治疗晚期恶性梗阻性黄疸操作简单、疗效确切、并发症少,能提高患者的生存质量.%[Objective] To investigate the curative effect and prognosis of advanced malignant obstructive jaundice with endoscopic retrograde cholangiopancreatography (ERCP) of metal stent placement. [Methods] Two hundreds and ninety-two cases of malignant biliary obstruction whose biliary stent insertions received ERCP from June 2003 to June 2010 in our hospital were reviewed retrospectively. And analysis of the percent of success, incidence of complications, clinic effect and prognosis was made. [Results] 96.23% patients were successfully inserted the bile duct metal stent with ERCP. Compared with the levels of the total bilirubin, direct bilirubin, alkaline phosphatase and alanine aminotransferase before operation ,the indexes decreased one week after the stent insertion (P<0.05). The main complications were infection, hemorrhage and pancreatitis. The incidence rate of complications was about 7.88%,The patients were remission after treatment and there was no operation related dead happened, the survival time was 7.21±4.68 month, the median survival time was 7.3month. [Conclusion] The curative effect in treatment of advanced malignant obstructive

  20. Malignant biliary obstruction: From palliation to treatment

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-01-01

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  1. Management of hilar bile duct carcinoma with high-dose radiotherapy and expandable metallic stent placement

    International Nuclear Information System (INIS)

    This article describes our experience with high-dose radiotherapy in combination with the placement of expandable metallic stents (EMS) in the management of hilar bile duct carcinoma. Between 1988 and 1999, 107 consecutive patients with hilar bile duct carcinoma were treated with EMS placement either alone or in combination with high-dose radiotherapy. External beam radiotherapy (EBRT) was indicated in 101 patients, and in 86 this was combined with intraluminal 192Ir irradiation (ILRT, 59-98 Gy) EMS were placed after the completion of radiotherapy. The 1-, 2-, 3-, and 5-year actuarial survival rates for the radiotherapy group were 66.4%, 23.4%, 15.6%, 7.8%, respectively, and the 1- and 2-year actuarial survival rates for the nonradiotherapy group were 66.4% and 0%, respectively. The placement of EMS was useful for the early establishment of an internal bile passage in radically irradiated patients and the 1-, 2-, 3-, and 5-year actuarial patency rates for the radiotherapy group were 56.3%, 45.3%, 35.2%, and 23.4%, respectively, and the 1- and 2-year actuarial patency rates for the non radiotherapy group were 50.0% and 0% respectively. High-dose radiotherapy, consisting of ILRT and EBRT, appears to be feasible in the management of hilar bile duct carcinoma, and it offers a survival advantage for patients no suited for surgical resection. The placement of EMS assists the internal bile flow and lengthens survival after high-dose radiotherapy. (author)

  2. Long-Term Outcome of Self Expandable Metal Stents for Biliary Obstruction in Chronic Pancreatitis

    OpenAIRE

    Alexander Waldthaler; Kerstin Schütte; Jochen Weigt; Peter Malfertheiner; Siegfried Kropf; Stefan Kahl

    2013-01-01

    Context Insertion of a self-expandable metal stent is still controversial for treatment of benign common bile duct stenosis but can be a valuable alternative to surgical treatment. Objective Aim of our study was to analyze the efficacy of covered and uncovered selfexpandable metal stent in patients with chronic pancreatitis and common bile duct stenosis. Material and methods Twenty patients with common bile duct stenosis due to alcoholic chronic pancreatitis were retrospective analyzed. All p...

  3. 不同金属胆道支架对恶性梗阻性黄疸疗效比较%Biliary stenting for the treatment of malignant obstructive jaundice:comparison study of different metallic stents

    Institute of Scientific and Technical Information of China (English)

    路绪龙; 白旭明; 程龙; 顾星石; 靳勇

    2014-01-01

    目的:评估两类常用金属支架治疗不同位置的恶性胆道梗阻支架通畅率及患者生存率。方法对126例因恶性胆道梗阻接受经皮经胆道金属支架植入治疗的患者进行回顾性分析,共植入金属胆道支架167枚,其中70例患者植入网状编织型支架92枚,56例患者植入激光雕刻型支架75枚。术后随访并比较患者支架通畅时间及生存时间。结果支架植入成功率为100%(126/126),网状型与激光型中位通畅时间分别为182 d、196 d,术后患者的中位生存时间分别为179 d、186 d。两组患者术后通畅率及生存率进行对比分析差异均无统计学意义(P >0.05)。结论网状型与激光型支架在治疗恶性胆道梗阻效果上基本等效。在一定程度上前者可起到替代作用。%Objective To evaluate the patency rate of two types of metallic biliary stent in treating malignant biliary stenosis, and to discuss the patient’s survival rate. Methods A total of 126 patients with malignant biliary stenosis were treated with percutaneous implantation of biliary stent. The clinical data were retrospectively analyzed. A total of 167 metallic biliary stents were used in 126 patients. Ninety - two metal stents of mesh type were employed in 70 cases, while 75 metal stents of laser engraving type were adopted in 56 cases. After the treatment all patients were followed up, and the stent patency time as well as the median survival time was determined. The results were analyzed and compared between the two types of stents. Results Technical success rate was 100% (126/126). The median patency rate time of mesh type and laser type was 182 days and 196 days respectively, the patient’s median survival time of mesh type group and laser type group was 179 days and 186 days respectively. No statistically significant differences in the stent patency time and in the median survival time existed between the two groups (P > 0.05). Conclusion In

  4. EUS-Guided Antegrade Transhepatic Placement of a Self-Expandable Metal Stent in Hepatico-Jejunal Anastomosis

    Directory of Open Access Journals (Sweden)

    Everson LA Artifon

    2011-11-01

    Full Text Available Context To demonstrate an EUS-guided biliary drainage in patient with gastrointestinal tract modified surgically. Case report An EUS guided access to the left intra hepatic duct, followed by an antegrade passage of a partially self-expandable metal stent that was removed by using an enteroscope, in one patient with hepatico-jejunal anastomosis. There were no early or delayed complications and the procedure was effective in relieving jaundice until the self-expandable metal stent was removed, 3 months later. A cholangiogram was obtained via enteroscopy, after removal of self-expandable metal stent, and found to be normal. The patient had an uneventful evaluation afterwards. Conclusion The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. EUS-guided biliary drainage is feasible when performed by professionals with expertise in biliopancreatic endoscopy and advanced echo-endoscopy and should be performed currently under rigorous protocol in educational institutions.

  5. Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents - results of an 8-year follow-up and analysis of the prognostic parameters

    International Nuclear Information System (INIS)

    Purpose: To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents. Materials and Methods: This is a retroselective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression. Results: Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99%, the complication rate 27% and the 30-day mortality 11%. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality. Conclusion: Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion. (orig.)

  6. Argon Plasma Coagulation Combined with Covered Stent Placement for Management of Tracheobronchial Stenoses/occlusions as well as Esophagorespiratory Fistulas

    OpenAIRE

    Hongwu WANG; Lingfei LUO; Yunzhi ZHOU; Ma, Hongming; Li, Jing; Zou, Heng; Li, Dongmei; Zhang, Nan

    2010-01-01

    Background and objective It is a complex problem and difficult treatment for tracheobronchial stenoses/occlusions involving in carina. The aim of this study is to investigate the feasibility and efficiency of argon plasma coagulation (APC) and bifurcated covered Z-type stents (CZTS) placement for the treatment of tracheobronchus stenoses and esophagorespiratory fistula (ERF). Methods Thirty-two cases with airway disorders were retrospectively reviewed for the treatment of APC and CZTS placeme...

  7. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent

    OpenAIRE

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-01-01

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis aft...

  8. Interventional treatment on vascular and biliary complications after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment on vascular and biliary complications after liver transplantation. Methods: Sixteen of 46 patients (15 males, 1 female, 17-60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. 15 cases received angiography and proved vascular complications and 4 cases received cholangiography and biliary complications were found. 3 of them appeared both vascular and biliary complications. Results: Hepatic artery complication was the most common complication (seen in 9/16 patients), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One case with hepatic artery thrombosis received transcatheter thrombolysis and two cases with bleeding received coil embolization. Stenosis of inferior vena cava and portal vein were observed in 6 and 2 patients respectively. After balloon angioplasty or stent placement, clinical symptom of all cases alleviated. Biliary complications including biliary stricture and anastomotic bile leak occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage. Conclusion: Interventional methods offered both diagnosis and mini-invasive treatment for patients after liver transplantation with vascular and biliary complications. Balloon angiography and stent placement of venous stenosis is an useful procedure for the treatment of these problems

  9. Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Xinopoulos; Stefanos P Bassioukas; Dimitrios Kypreos; Dimitrios Korkolis; Andreas Scorilas; Konstantinos Mavridis; Dimitrios Dimitroulopoulos; Emmanouil Paraskevas

    2011-01-01

    AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access.METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannu-lation success and post-endoscopic retrograde cholan-giopancreatography (ERCP) complication rate.RESULTS: SGT (92.3% success rate) was character-ized by statistically significant enhanced patient out-come compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favor-able outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients' gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is con-sidered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is neces-sary in difficult-to-cannulate cases.

  10. Endoscopic management of benign biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Benign biliary strictures are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has evolved over the last 2 decades as the current standard of care. The most common etiologies of strictures encountered are following surgery and those related to chronic pancreatitis. High-quality cross-sectional imaging provides a road map for endoscopic management. Currently, sequential placement of multiple plastic biliary stents represents the preferred approach. There is an increasing role for the treatment of these strictures using covered metal stents, but due to conflicting reports of efficacies as well as cost and complications, this approach should only be entertained following careful consideration. Optimal management of strictures is best achieved using a team approach with the surgeon and interventional radiologist playing an important role.

  11. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture – a case report and literature review

    International Nuclear Information System (INIS)

    Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Frequency of angioplasty and vascular stent implantation procedures is increased in patients

  12. Post-sphincterotomy bleeding: fully-covered metal stents for hemostasis

    OpenAIRE

    DeBenedet, Anthony T; Elta, Grace H

    2013-01-01

    Background/objectives: In endoscopic retrograde cholangiopancreatography, post-sphincterotomy bleeding (PSB) is a common complication of biliary sphincterotomy. Recently, the temporary placement of fully-covered metal stents (FCMS) into the biliary tree in order to achieve a tamponade effect has been described as an additional therapeutic option for PSB. The aim of this article is to review the literature on FCMS for hemostasis in PSB and update the treatment algorithm for this complication. ...

  13. Transurethral resection of fibrotic scar tissue combined with temporary urethral stent placement for patients with in anterior urethral stricture

    Directory of Open Access Journals (Sweden)

    Cheol Yong Yoon

    2014-08-01

    Full Text Available Introduction Fibrotic scar formation is a main cause of recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU. In the present study, we devised a new technique of combined the transurethral resection of fibrotic scar tissue and temporary urethral stenting, using a thermo-expandable urethral stent (MemokathTM 044TW in patients with anterior urethral stricture. Materials and Methods As a first step, multiple incisions were made around stricture site with cold-cutting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a MemokathTM 044TW stent (40 – 60mm on a pre-mounted sheath using 0° cystoscopy. Stents were removed within 12 months after initial placement. Results We performed this technique on 11 consecutive patients with initial (n = 4 and recurrent (n = 7 anterior urethral stricture (April 2009 – February 2013. At 18.9 months of mean follow-up (12-34 months, mean Qmax (7.8±3.9ml/sec vs 16.8 ± 4.8ml/sec, p < 0.001, IPSS (20.7 vs 12.5, p = 0.001 , and QoL score (4.7 vs 2.2, p < 0.001 were significantly improved. There were no significant procedure-related complications except two cases of tissue ingrowth at the edge of stent, which were amenable by transurethral resection. In 7 patients, an average 1.4 times (1-5 times of palliative urethral dilatation was carried out and no patients underwent open surgical urethroplasty during the follow-up period. Conclusion Combined transurethral resection and temporary urethral stenting is a effective therapeutic option for anterior urethral stricture. Further investigations to determine the long-term effects, and safety profile of this new technique are warranted.

  14. Clinical observation of biliary tract stent insertion combined with iodine-125 seeds in treatment of malignant obstructive jaundice%载125Ⅰ粒子胆管支架植入治疗恶性梗阻性黄疸的临床观察

    Institute of Scientific and Technical Information of China (English)

    李晓刚; 陆平; 李波; 罗开元

    2013-01-01

    Objective To observe the effect of biliary stent insertion combined with iodine-125 seeds in treatment of malignant obstructive jaundice. Methods Fifteenth patients with malignant biliary obstruction were treated by metallic biliary stent insertion combined with iodine-125 seeds. Total bilirubin (TBIL) and alkaline phosphatase (ALP) levels, the medium survival time and survival rate were analyzed retrospectively. Results Serum TBIL and ALP levels were markedly decreased 2 weeks after placement of biliary stent and iodine-125 seeds, and turned to the normal level at 4th week in 7 patients. The medium survival time was 12 months. The half-, one- and two-year survival rate was 73.3%, 40. 0% and 13. 3% respectively. Conclusion Biliary stent insertion combined with iodine-125 seeds therapy in treating patient with malignant obstructive jaundice may improve the quality of life and increase the survival rate.%目的 观察经皮肝穿刺载125 I粒子胆管支架植入治疗恶性梗阻性黄疸的疗效.方法 对15例接受载125I粒子胆管支架植入治疗的恶性梗阻性黄疸患者,观察血清总胆红素(TBIL)和碱性磷酸酶(ALP)的变化,以及治疗后的生存时间和生存率.结果 术后2周,TBIL和ALP较术前明显下降(P<0.01);术后4周,TBIL和ALP恢复正常者7例.15例的中位生存时间为12个月,半年、1年及2年生存率分别为73.3%(11/15)、40.0%(6/15)及13.3%(2/15).结论 无法外科手术治疗的恶性梗阻性黄疸,经皮肝穿刺载125I粒子胆管支架植入治疗能明显提高患者的生活质量及生存率.

  15. 彩色多普勒超声在行经皮肝行胆道内支架置入术中的价值探讨%Evaluation of the clinical value of the color doppler ultrasound in percutaneous biliary stenting line

    Institute of Scientific and Technical Information of China (English)

    谭碧波; 郑梦琳; 郭佳; 李万斌; 韩亮

    2015-01-01

    Objective To evaluate the clinical value of color Doppler ultrasound in percutaneous biliary stenting line . Methods With the aid of color Doppler ultrasound ,intradermal biliary tract stenting operation was conducted in 68 pa‐tients with obstructive jaundice ,in which 59 cases were malignant obstructive jaundice patients and 9 were benign obstruc‐tive jaundice .There were five cases of unilateral have bile duct dilatation and 63 cases of bilateral bile duct dilatation .The inner diameter of the bile ducts was 3 ~ 18 mm ,with an average of 5 .8 mm .Of those patients ,61 were subjected to uni‐lateral biliary stenting ,seven to both biliary stenting ,with a total of 75 times of biliary stent placements .Postoperatively , relevant laboratory parameters and color Doppler sonography were performed and compared with the preoperative results . Results Of those 75 times of biliary stent placements on the 68 patients who required for percutaneous biliary stenting ,71 times were conducted successfully by once ,accounting for 95% ;the first operation on the remaining four cases were failed and then a second elective operation was successfully performed ,with secondary success rate of 100% .Related laboratory indicators had been improved in all patients after surgery ,no significant biliary dilatation was revealed ,and color Doppler ultrasound can clearly observe the biliary metallic stent placement , with no serious complications .Conclusion Color Doppler ultrasound in percutaneous biliary stenting line has a very important clinical value .%目的:探讨彩色多普勒超声在经皮肝行胆道内支架置入术中的临床应用价值。方法在彩色多普勒超声辅助下对68例梗阻性黄疸的患者进行经皮肝胆道内支架置入术的操作,其中恶性梗阻性黄疸患者59例,良性梗阻性黄疸的患者9例。单侧胆管扩张5例,双侧胆管同时扩张63例。扩张胆管内径3~18mm ,平均5.8mm 。其中61例患者进行了单

  16. 内镜金属支架姑息性治疗胆管远端恶性梗阻272例分析%272 cases of distal malignant biliary obstruction palliatively treated in endoscopic metal biliary stent

    Institute of Scientific and Technical Information of China (English)

    吴瑜; 秦鸣放; 王庆; 勾承月; 李宁

    2011-01-01

    [ Objective ] To explore the therapeutic effect and clinic value of distal malignant biliary obstruction in endoscopic metal biliary stent. [ Method ] The clinical data of 272 cases of distal malignant biliary obstruction unreseetable were retrospectively analyzed. The patients were treated in endoscopic metal biliary stent from December of 2000 to December of 2009. [ Result ] Endoscopic retrograde cholangio pancreatography were successfully performed in 258 cases (258/272, 94.8%). The levels of TBIL and DBIL were restored (73.3%) after stents were implanted two weeks later. Complications were cured including acute cholangititis in 13 patients (5.0%) and hyperamylascmia in 10 patients (3.9%). Follow-up observation was of 182 cases. Average survivng time was (24 ± 3.3) months (range: 3~37 months) after endoscopic metal biliary stent treatment. 1 year survival was 51.4% (94/182) and 2 year survival was 2.1% (40/182). [Conclusion] Metal stent implantation is safe and effective to relive obstruction for inoperable patients of malignant biliary obstruction with fewer invasive, fewer complication,better improvement of hepatic function and accord with physiology.%目的 探讨内镜金属支架对胆管远端恶性梗阻的治疗效果和临床应用价值.方法 回顾性分析该院2000年12月至~2009年12月内镜金属支架治疗272例无法手术根治性切除的胆管远端恶性梗阻患者的临床资料.结果 272例插管成功258例,失败14例,成功率为94.8%.术后2周胆红素降至正常189例(73.3%).术后并发急性胆管炎13例(5.0%),高淀粉酶血症10例(3.9%),均经保守治疗痊愈.随访182例,平均生存时间(24±3.3)个月(3~37个月),1年生存率为51.4%(94/182),2年生存率为22.1%(40/182).结论 对无法手术根治性切除的恶性胆管远端梗阻患者,内镜金属支架治疗可有效解除胆管梗阻,改善肝功能,同时具有创伤小、并发症少、符合生理等特点.该方法是安全、有效的.

  17. Dutch iliac stent trial : Long-term results in patients randomized for primary or selective stent placement

    NARCIS (Netherlands)

    Klein, W.M.; van der Graaf, Y.; Seegers, J.; Spithoven, J.H.; Buskens, E.; van Baal, J.G.; Buth, J.; Moll, F.L.; Overtoom, T.T.C.; van Sambeek, M.R.H.M.; Mali, W.P.T.M.

    2006-01-01

    Purpose: To determine long-term results of the prospective Dutch Iliac Stent Trial. Materials and Methods: The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with

  18. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

    Energy Technology Data Exchange (ETDEWEB)

    Dale, Adam P., E-mail: adamdale@doctors.org.uk [Basingstoke and North Hampshire Hospital, Department of Medical Microbiology (United Kingdom); Khan, Rafeh, E-mail: rafeh.khan@yahoo.com; Mathew, Anup, E-mail: anup.mathew@sth.nhs.uk; Hersey, Naomi O., E-mail: Naomi.Hersey@sth.nhs.uk; Peck, Robert, E-mail: Robert.Peck@sth.nhs.uk; Lee, Frederick, E-mail: fred.lee@sth.nhs.uk [Northern General Hospital, Department of Radiology (United Kingdom); Goode, Stephen D., E-mail: S.Goode@sheffield.ac.uk [Northern General Hospital, Sheffield Vascular Institute (United Kingdom)

    2015-10-15

    PurposePTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.Materials and MethodsHaemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.ResultsHaemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.ConclusionIntroduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.

  19. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

    International Nuclear Information System (INIS)

    PurposePTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.Materials and MethodsHaemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.ResultsHaemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.ConclusionIntroduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract

  20. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jun Qian; Ren-You Zhai; Ding-Ke Dai; Ping Yu; Li Gao

    2006-01-01

    AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease.METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients Accepted: brachytherapy or extraradiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis.RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholangiocarcinoma, 4 cases of pancreatic carcinoma), and 13patients Accepted: brachytherapy (7 cases of cholangiocarcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively,longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%,80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group.CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.

  1. Material characteristics and biocompatibility of plastic and metal biliary stents%塑料与金属胆管支架的材料特征及其生物相容性

    Institute of Scientific and Technical Information of China (English)

    赵冬梅; 蒋丹娜; 刘侠

    2011-01-01

    BACKGROUND: Implantation of plastic and metal biliary stent under digestive endoscopy is an effective means in the treatment of benign and malignant bile duct obstruction. Particularly stent implantation provides great clinical application value for high biliary obstruction in biliary cancer patients who are not suitable for surgical treatment and need to eliminate jaundice,accommodate physiologic d rainage, prolong survival, and improve quality of life.OBJECTIVE: To compare the clinical effects of endoscopic implantation of plastic and metal biliary stents in the treatment of benign and malignant bile duct obstruction, and to explore the biocompatibility of plastic and metal biliary stents with the host.METHODS: Using "bile duct obstruction, plastic biliary stent, metal biliary stent, biocompatibility" in Chinese and "cerebrovascular disease, stent, biocompatibility" in English as the key words, China Academic Journal Full-text Database (CNKI:1989/2009) and Medline (1989/2009) database were searched online by the first author. Meta analysis and repeatable studies were excluded. Totally 35 studies were screened and evaluated, focusing on the research progress, complications, and biocompatibility in treatment of plastic and metal biliary stent.RESULTS AND CONCLUSION: Endoscopic biliary stent implantation is the principal means in the treatment of benign and malignant biliary obstruction. Biliary stent includes metal stent and plastic stent. Metal stents have exhibited great advantages in preventing the growth of bacteria and maintaining stent patency, but the price is expensive. Plastic stents are easy for bacterial attachment, biliary sludge deposition causes stent obstruction, but they are easy to replace and low price. The biocompatibility of plastic and metal biliary stents needs to be improved, for patients with malignant biliary obstruction, bile duct stent implantation in combined with radiation therapy will help to prevent stent obstruction. Further

  2. Radiologic and Clinical Outcomes with Special Reference to Tumor Involvement Pattern after Stent Placement for Malignant Bronchial Obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Song, Ho-Young; Kim, Kyung-Rae; Kim, Jin Hyoung (Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea)); Kim, Sang Wee; Lee, Dae-Ho; Hong, Sang-Beom (Internal Medicine, Univ. of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea))

    2009-11-15

    Background: Location of tumor within the tracheobronchial tree as well as its severity can affect the clinical outcome of patients who undergo airway stent placement. Purpose: To evaluate radiologic and clinical outcome, including survival data, with special reference to proposed tumor involvement pattern, in patients with malignant bronchial strictures. Material and Methods: A total of 35 patients who underwent stent placement for malignant bronchial strictures were enrolled over a 9-year period. Tumor involvement pattern was divided into three types based on computed tomography (CT) scans and selective bronchography. Type I was defined as tumor involving only the main stem bronchus; type II, tumor involving the bronchus intermedius and/or the lower lobar bronchus without involvement of the lower-lobe segmental bronchus; and type III, tumor involving the lower lobar bronchus with involvement of the lower-lobe segmental bronchus. Tumor stage, lung collapse/infiltration, radiologic improvement, clinical improvement, and survival were compared according to the tumor involvement pattern. Results: Tumor involvement pattern was of type I, II, and III in 14, 13, and eight patients, respectively. When comparisons were made between types I/II and type III to evaluate the influence of lower-lobe segmental bronchial involvement, radiologic and clinical improvement was significantly lower in type III than in types I/II, while advanced stage, lung collapse/infiltration, and median overall survival were not significantly different between types I/II and type III. Conclusion: In patients with malignant bronchial obstructions involving the lower-lobe segmental bronchus, clinicians must be aware of the possibility of less radiologic and clinical improvement following stent placement

  3. Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kalmar, Peter I., E-mail: peter.kalmar@medunigraz.at; Portugaller, Rupert H., E-mail: rupert.portugaller@medunigraz.at; Schedlbauer, Peter, E-mail: peter.schedlbauer@klinikum-graz.at; Bohlsen, Dennis, E-mail: dennis.bohlsen@medunigraz.at; Deutschmann, Hannes A., E-mail: hannes.deutschmann@medunigraz.at

    2014-07-15

    Purpose: Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries. Materials and methods: Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery. Results: Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328). Conclusions: The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents.

  4. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent.

    Science.gov (United States)

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-02-16

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement. PMID:21403817

  5. Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation in Children: Top-Down Suturing Technique Without Stent Placement.

    Science.gov (United States)

    Silay, Mesrur Selcuk; Baek, Minki; Koh, Chester J

    2015-08-01

    Extravesical robotic-assisted laparoscopic ureteral reimplantation in children is a challenging procedure. Our top-down suturing technique facilitates this reconstructive surgery. After mobilization of the ureter without the use of ureteral stent placement, the detrusor muscle is divided. Once adequate muscle flaps are raised, the ureter is placed into its new muscle tunnel. Unlike previously described techniques, the top-down suturing approach involves placement of the first detrusor stitch at the superior aspect. This allows the ureter to be elevated out of harm's way and in a tension-free manner. The rest of the detrusor reapproximation is performed in a top-down approach with interrupted sutures without the need for ureteral elevation or manipulation. This technique facilitates the suturing process and decreases trauma to the ureter with less instrument contact. This helps to prevent potential complications and improve success rates associated with this procedure. PMID:25674670

  6. The role of sonography in imaging of the biliary tract.

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

    Sonography is the recommended initial imaging test in the evaluation of patients presenting with right upper quadrant pain or jaundice. Dependent upon clinical circumstances, the differential diagnosis includes choledocholithiasis, biliary stricture, or tumor. Sonography is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with sonographically documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial sonographic documentation of choledocholithiasis, endoscopic ultrasound or magnetic resonance cholangiopancreatography is the next logical imaging step. Endoscopic ultrasound documentation of choledocholithiasis in a postcholecystectomy patient should lead to retrograde cholangiography, sphincterotomy, and clearance of the ductal calculi by endoscopic catheter techniques. In patients with clinical and sonographic findings suggestive of malignant biliary obstruction, a multipass contrast-enhanced computed tomography (CT) examination to detect and stage possible pancreatic carcinoma, cholangiocarcinoma, or periductal neoplasm is usually recommended. Assessment of tumor resectability and staging can be performed by CT or a combination of CT and endoscopic ultrasound, the latter often combined with fine needle aspiration biopsy of suspected periductal tumor. In patients whose CT scan suggests hepatic hilar or central intrahepatic biliary tumor, percutaneous cholangiography and transhepatic biliary stent placement is usually followed by brushing or fluoroscopically directed fine needle aspiration biopsy for tissue diagnosis. Sonography is the imaging procedure of choice for biliary tract intervention, including cholecystostomy, guidance for

  7. 内镜下同期胆、肠双金属支架置入治疗胆管及十二指肠恶性梗阻%Simultaneous stenting in bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    潘亚敏; 王田田; 高道键; 吴军; 胡冰

    2013-01-01

    Objective To investigate the therapeutic strategies, methods, safety and efficacy of simultaneous placement of self-expanding metallic stent (SEMS) in the bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction. Methods The clinical data of patients with obstructive jaundice combined with severe duodenal stricture, who were treated with simultaneous placement of biliary SEMS and duodental SEMS under endoscope during January 2009 to June 2012, were retrospectively analyzed. The success rate of endoscopic management, complications, relief of jaundice and results of gastric outlet obstruction scoring system (GOOSS) were analyzed. Results Totally ten patients meeting the criteria were analyzed in this study. The patients included 5 cases with pancreatic cancer, 2 with gallbladder cancer, 2 with cancer of bile duct and one with duodenal papilla caner. Five patients with type Ⅰ duodenal stricture (without invading duodenal papilla) successfully received biliary stents through endoscopic retrograde cholangiopancreatography (ERCP) after placement of duodenal stents. One patient with type Ⅰ duodenal stricture was implanted with a 9 cm duodenal stent before endoscopic anterograde cholangiopancreatography (EACP) , then a SEMS was implanted in the bile duct through endoscopic ultrasonography-guided biliary drainage (EUS-BD). Three patients with type Ⅱ duodenal stricture (with invading duodenal papilla) underwent EACP and biliary stent placement through EUS-BD, and then the duodenal stent was deployed in duodenum after EACP. The patient with type Ⅲ (away from the duodenal papilla) was implanted with biliary and duodenal stents. The success rate of endoscopic management was 100%. Two patients had self-controlled bleeding of intestinal mucosa, which was caused by endoscope friction when passing through the duodenal stricture, but without any continuous bleeding or perforation. Symptoms of jaundice and gastric outlet obstruction

  8. Numerical analysis of airflow alteration in central airways following tracheobronchial stent placement

    Directory of Open Access Journals (Sweden)

    Ho Chien-Yi

    2012-08-01

    Full Text Available Abstract The computational fluid dynamics method, which provides an estimation of the pressure drop in the airway before and after the stent implantation, is proposed in this study. This method is based on the finite volume model. The pressure field was solved by the Navier-Stokes equations. The proposed methodology was evaluated in seven health people (control group and in fourteen patients who were assigned in two groups, in which one was tracheal stenosis and the other was bronchial stenosis. The results showed that the pressure drop after tracheal stent implantation became significantly smaller. For bronchial stent implantation cases, the airway resistance improved insignificantly.

  9. 内镜下同期放置双侧金属支架或双侧塑料支架治疗肝门部恶性胆道梗阻%Simultaneous bilateral biliary metal stents versus plastic stents under endoscope for treatment of malignant hilar biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    王田田; 潘亚敏; 高道键; 吴军; 杨小明; 叶馨; 胡冰

    2013-01-01

    目的 比较经内镜同期置入双侧金属支架或双侧塑料支架治疗肝门部恶性胆道梗阻(MHBO)的疗效及安全性.方法 选取2007年5月至2011年12月需要进行双侧胆道引流的142例MHB()患者,其中32例采用双侧金属支架胆道引流(双金属支架组),110例采用双侧塑料支架胆道引流(双塑料支架组),统计内镜操作成功率、术后减黄有效率、内镜逆行胆胰管造影(ERCP)术后并发症及支架通畅期.结果 全组操作成功率为100%.双金属支架组和双塑料支架组术后减黄有效率分别为96.9%(31/32)和88.2% (97/110),组间差异无统计学意义(P>0.05).双金属支架组和双塑料支架组ERCP术后分别出现2例和6例胆管炎,经抗炎对症、更换支架或置入鼻胆管处理后症状缓解;双塑料支架组出现2例支架部分滑脱.两组均未发生胰腺炎、消化道出血、穿孔及ERCP相关性死亡病例.至研究终点,双金属支架组和双塑料支架组分别有2例和4例因其他原因死亡,死亡时胆道内支架均通畅;双金属支架组和双塑料支架组分别有8例和29例再发梗阻性黄疸,予以重新置入或更换塑料支架处理.两组ERCP术后并发症发生率差异无统计学意义(P>0.05).双金属支架组的中位通畅期为(248.53±138.61)d,双塑料支架组的中位通畅期为(101.76±38.53)d,经Log-rank检验差异有统计学意义(P<0.001).结论 对于BismuthⅡ型或双侧胆管均已受侵、无法手术的MHBO,如果胆道引流范围许可、患者的预计生存期>3个月,双金属支架行胆道引流更具优势.%Objective To compare the safety and efficacy of simultaneous bilateral biliary metal stents with plastic stents under endoscope for treatment of malignant hilar biliary obstruction (MHBO). Methods From May 2007 to December 2011, 142 MHBO patients were selected for this study, with 32 receiving bilateral metal stent drainage and 110 receiving bilateral plastic stent

  10. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study

    Directory of Open Access Journals (Sweden)

    Canena Jorge Manuel

    2012-06-01

    Full Text Available Abstract Background Refractory benign esophageal strictures (RBESs have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 types of stents: self-expanding plastic stents (SEPSs, biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs, for the treatment of RBES. Methods This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10, biodegradable stents (n = 10 or FCSEMSs (12 weeks, n = 10. Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions. Results Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60% in the SEPS group, 2 (20% in the biodegradable group and 3 (30% in the FCSEMS group (P = 0.16. A total of 8/30 patients (26.6% were dysphagia-free after the end of follow-up: 1 (10% in the SEPS group, 3 (30% in the biodegradable group and 4 (40% in the FCSEMS group (P = 0.27. More reinterventions were required in the SEPS group (n = 24 than in the biodegradable group (n = 13 or the FCSEMS group (n = 13 (P = 0.24. Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011. Conclusions Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.

  11. The Efficacy and Safety of Endoscopic Balloon Dilation Combined with Stenting in Patients with Biliary Anastomotic Strictures After Orthotopic Liver Transplantation.

    Science.gov (United States)

    Peng, Chunyan; Ma, Chao; Xu, Guifang; Shen, Shanshan; Lv, Ying; Zou, Xiaoping

    2015-06-01

    Endoscopic balloon dilation combined with stenting has been increasingly used in managing biliary anastomotic strictures (BAS) after orthotopic liver transplantation (OLT). However, data on the efficacy and safety vary among different studies. To obtain reliable estimates for the efficacy and safety of this endoscopic combination therapy in post-OLT BAS. A systematic search was conducted in the literature published until June 2012. The outcomes of individual study were transformed into comparable data using the Freeman-Tukey double arcsine transformation method. Fixed-effect or random-effect models were built to simulate the outcomes. Subgroup analysis and meta-regression were used to explore the sources of clinical heterogeneity. Clinical resolution and recurrence were defined as the primary outcomes and complications and mortality as secondary outcomes. Nineteen studies (15 retrospective, 4 prospective; 17 full-texts, 2 abstracts) were included, with a total of 745 patients. Fully covered self-expandable metal stent was only reported in one study, achieving a resolution rate of 92.3 %, recurrence rate of 8.3 %, and complication rate of 7.7 %. For 18 studies using plastic stents, the pooled resolution rate was 86 % (95 % CI 80-91 %; I (2) = 74.7 %). Abstracts, study design, and the delay from OLT to BAS diagnosis were contributing factors for heterogeneity in resolution. The pooled recurrence rate was 9 % (95 % CI 5-13 %; I (2) = 59.6 %). Longer stenting duration predicted less recurrence (OR = 0.95, p = 0.002). The pooled complication rate was 14 % (95 % CI 8-21 %, I (2) = 71.2 %). No procedure-related mortality was reported. Endoscopic balloon dilation combined with stenting is a relatively effective and safe modality in post-OLT BAS. PMID:25552252

  12. Simple mesh stent placement for treating intracranial aneurysm: progress in research

    International Nuclear Information System (INIS)

    Treatment of an aneurysm with a mesh stent alone becomes an emerging technique. The mechanism involves the mesh stents, when it crosses the neck of an aneurysm could change the internal circulation and induce the formation of stable thrombus and in turn assists the growth of neointima for anatomical healing of the aneurysmal neck. The mesh stent technique aimed at vascular reconstruction with expected curing effect for aneurysm together as a simple and safe way to keep the patency of the small arterial branches, just contrary to the covered stent. This technique couldn't be carried out practically in wide scale because of immaturity, therefore we give a comprehesive review in the progress of this field. (authors)

  13. SEMS vs cSEMS in duodenal and small bowel obstruction: High risk of migration in the covered stent group

    OpenAIRE

    Waidmann, Oliver; Trojan, Jörg; Friedrich-Rust, Mireen; Sarrazin, Christoph; Bechstein, Wolf Otto; Ulrich, Frank; Zeuzem, Stefan; Albert, Jörg Gerhard

    2013-01-01

    Aim: To compare clinical success and complications of uncovered self-expanding metal stents (SEMS) vs covered SEMS (cSEMS) in obstruction of the small bowel. Methods: Technical success, complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed. The primary end points were rates of stent migration and overgrowth. Secondary end points were the effect of concomitant biliary drainage on migration rate a...

  14. Endoscopic treatment of malignant biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.

  15. Stent-Graft Placement with Early Debridement and Antibiotic Treatment for Femoral Pseudoaneurysms in Intravenous Drug Addicts

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Qining, E-mail: cqmufqn@163.com; Meng, Xiyun, E-mail: 383274177@qq.com; Li, Fenghe, E-mail: lfh-cqmu@gmail.com; Wang, Xuehu, E-mail: 184037696@qq.co; Cheng, Jun, E-mail: cqdcj@163.com; Huang, Wen, E-mail: dhuangwen@hotmail.com; Ren, Wei, E-mail: renwei9771@yahoo.com.cn; Zhao, Yu, E-mail: zhaoyu-cqmu@126.com [The First Affiliated Hospital of Chongqing Medical University, Department of Vascular Surgery (China)

    2015-06-15

    PurposeExplore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.Materials and MethodsWe evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.Results15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.ConclusionsSG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.

  16. A novel biodegradable biliary stent in the normal duct hepaticojejunal anastomosis: an 18-month follow-up in a large animal model.

    Science.gov (United States)

    Laukkarinen, Johanna M; Sand, Juhani A; Chow, Pierce; Juuti, Hanne; Kellomäki, Minna; Kärkkäinen, Päivi; Isola, Jorma; Yu, Sidney; Somanesan, Satchithanantham; Kee, Irene; Song, In Chin; Ng, Teck Hin; Nordback, Isto H

    2007-06-01

    Creating a well-functioning hepaticojejunostomy (HJ) anastomosis with nondilated bile ducts remains a challenge. Our aim was to study the use in a large animal model of a novel, braided polylactide barium sulfate biodegradable biliary stent (BDBS) without external connection and with no need for later removal. Fifty swine were randomly operated on for Roux-Y HJ with or without BDBS in the anastomosis, and followed up (dynamic biligraphy, x-ray, serum determinations, anastomosis inner diameter, and histology) for 1.5, 3, 6, 12, and 18 months. During the follow-up, one nonstented animal died because of anastomotic leakage. In x-ray BDBS was seen in place until 1.5 months in all of the stented animals. In the nonstented animals HJ anastomosis inner diameter was decreased at 18 months [6.3 (5.0-7.0) mm vs 7.4 (7.0-9.0) mm, p = 0.05] and liver clearance reduced at 12 and 18 months compared to stented animals. Serum liver values and liver and bile duct histology did not differ between the groups. We conclude that this novel BDBS is easy to insert into the HJ anastomosis with nondilated ducts. It is nontoxic, dissolves safely, and may be associated with a larger and better draining anastomosis at 18-month follow-up. These results encourage us to proceed to clinical studies. PMID:17436052

  17. Feasibility of application of anti-reflux metallic stent for malignant biliary obstruction%抗反流金属支架用于胆道恶性梗阻的可行性研究

    Institute of Scientific and Technical Information of China (English)

    王田田; 胡冰; 潘亚敏; 时之梅; 王书智; 陆蕊; 黄慧; 王淑萍

    2010-01-01

    目的 评价抗反流金属支架用于非肝门部胆道恶性梗阻的安全性和有效性.方法 对符合标准的2007年8月至2009年4月诊断为胆总管下段或中段恶性梗阻的患者采用抗反流金属支架进行治疗,记录操作成功率,随访观察早期并发症、支架通畅期和生存期.结果 共有23例无法切除的非肝门部胆道恶性梗阻的患者被纳入研究,均一次性成功置入抗反流金属支架,操作难度与普通自膨式金属支架(SEMS)大致相当,无操作相关并发症.22例患者完成随访,其中20例患者血清总胆红素水平在术后1个月内降至正常水平.有6例患者在随访期内发生支架失效,其中肿瘤组织长入支架腔内1例、超出支架端部2例、支架移位3例;其余患者至随访终点或死亡均未出现胆道症状.抗反流金属支架的中位通畅期为14个月,第3、6和12个月的支架通畅率分别为95.1%、74.2%和55.9%;患者的生存期为1~14个月,平均7.9个月,在术后第3、6和12个月的生存率分别为91.0%、81.3%和17.2%.结论 应用抗反流金属支架治疗低位胆道恶性梗阻在技术上是可行的,并且是安全和有效的.%Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in

  18. Evaluation of the Effects of Temporary Covered Nitinol Stent Placement in the Prostatic Urethra: Short-Term Study in the Canine Model

    International Nuclear Information System (INIS)

    Purpose. To evaluate the effect of temporary stent placement on the canine prostatic urethra. Methods. Retrievable PTFE-covered nitinol stents were placed in the prostatic urethras of 8 beagle dogs under fluoroscopic guidance. Retrograde urethrography was obtained before and after stenting. Retrograde urethrography and endoscopy were performed 1 and 2 months after deployment. The endoscopic degree of hyperplasia was rated on a scale of 0 to 4 (0 absence, 4 = occlusion). On day 60, stents were removed and urethrography was performed immediately before euthanasia. Pathologic analysis was performed to determine the degree of glandular atrophy, periurethral fibrosis, and urethral dilation. Results. Stent deployment was technically successful in 7 animals, and failed in 1 dog due to a narrow urethral lumen. Complete migration was seen in 2 animals at 1 month, and an additional stent was deployed. On day 30, endoscopy showed slight hyperplasia (grade 1) in 3 animals. On day 60, moderate hyperplasia (grade 2) was evidenced in 4 cases. No impairment of urinary flow was seen during follow-up. Retrieval was technically easy to perform, and was successful in all dogs. The major histologic findings were chronic inflammatory cell infiltrates; prostate glandular atrophy, with a mean value of 1.86 (SD 0.90); periurethral fibrosis, with a mean ratio of 29.37 (SD 10.41); and dilatation of the prostatic urethra, with a mean ratio of 6.75 (SD 3.22). Conclusion. Temporary prostatic stent placement in dogs is safe and feasible, causing marked enlargement of the prostatic urethral lumen. Retrievable covered stents may therefore be an option for bladder outlet obstruction management in men

  19. The progress of biodegradable biliary stents%生物可降解胆道内支架的研究进展

    Institute of Scientific and Technical Information of China (English)

    黄浩哲; 李文涛

    2013-01-01

    Biodegradable stents have achieved encouraging outcomes in the treatment of benign bile duct stenosis with good biocompatibility,unique biodegradation,and adept physical and mechanical performance.They have a higher biocompatibility than plastic and metal stents and do not require a second surgery for removal.This prevents adverse reactions like restenosis and the tendency to punch and bleed.These biodegradable stents provide a new method of treatment for biliary tract disease,and this review will focus on the animal experiments,clinical application,and future prospects of these stents.%生物可降解支架凭借良好的生物相容性、物理学性能和独特的可降解性,在良性胆管狭窄治疗中已经取得了令人鼓舞的效果.它弥补了塑料支架和金属支架生物相容性较差以及二次手术再取出等不足,克服了再狭窄、易穿孔及出血等不良反应,提供了治疗胆道疾病的新方法,具有广阔的应用前景.该文从生物可降解支架简介、动物实验和临床应用以及未来展望三个方面对其进行了阐述.

  20. Evaluation of hemodynamics changes during interventional stent placement using Doppler optical coherence tomography

    Science.gov (United States)

    Vuong, Barry; Genis, Helen; Wong, Ronnie; Ramjist, Joel; Jivraj, Jamil; Farooq, Hamza; Sun, Cuiru; Yang, Victor X. D.

    2015-03-01

    Carotid atherosclerosis is a critical medical concern that can lead to ischemic stroke. Local hemodynamic patterns have also been associated with the development of atherosclerosis, particularly in regions with disturbed flow patterns such as bifurcations. Traditionally, this disease was treated using carotid endarterectomy, however recently there is an increasing trend of carotid artery stenting due to its minimally invasive nature. It is well known that this interventional technique creates changes in vasculature geometry and hemodynamic patterns due to the interaction of stent struts with arterial lumen, and is associated with complications such as distal emboli and restenosis. Currently, there is no standard imaging technique to evaluate regional hemodynamic patterns found in stented vessels. Doppler optical coherence tomography (DOCT) provides an opportunity to identify in vivo hemodynamic changes in vasculature using high-resolution imaging. In this study, blood flow profiles were examined at the bifurcation junction in the internal carotid artery (ICA) in a porcine model following stent deployment. Doppler imaging was further conducted using pulsatile flow in a phantom model, and then compared to computational fluid dynamics (CFD) simulation of a virtual bifurcation to assist with the interpretation of emphin vivo results.

  1. Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction%经皮肝穿刺胆道腔内射频消融联合胆道支架治疗恶性胆道梗阻的临床观察

    Institute of Scientific and Technical Information of China (English)

    张凯; 张萌帆; 任建庄; 黄郭灏; 王艳丽; 段旭华; 陈鹏飞; 韩新巍

    2015-01-01

    Objective To investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy)in the treatment of malignant obstructive jaundice.Methods This study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014.Nine of them (test group)under-went percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement.The other 11 similar cases (control group)un-derwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography.Operative complications and remis-sion of jaundice were observed,and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups.Results All patients were followed completely by outpatient or telephone.The stent patency rate at 3 months after operation was 9 /9 in the test group and 8 /11 in the control group (χ2 =2.888,P =0.218),and the stent patency rates at 6 months were 7 /8 and 3 /11,re-spectively (χ2 =6.739,P =0.02).During follow -up,one case in the test group died of gastrointestinal bleeding at 113 d after operation;one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. Conclusion Percutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction,and the preliminary efficacy in prolonging the patency of self -expanding metallic stent is satisfactory.However,this therapy needs to be further ver-ified via large -sample randomized controlled studies.%目的:探讨经皮肝穿刺胆道腔内射频消融技术姑息性治疗恶性梗阻性黄疸的安全性及可行性。方法选取2013年1月-2014年3月接受治疗的20例无法切除的恶性梗阻性黄疸患者作为实验组,其中9例不能外科手术切除患者透视下

  2. Hemobilia after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the occurance and management for patients with hemobilia after percutaneous transhepatic biliary drainage (PTBD). Methods: Consecutive 139 patients with inoperable obstructive jaundice were treated by PTBD. After taking percutaneous transhepatic cholangiography, procedure of puncturing the dilated biliary duct with metallic stent or plastic catheter placement was undertaken. Follow up was carded out with clinical, radiographic and laboratory evaluation. Procedure-and device-related complications were also recorded. Results: All patients went though PTBD successfully with total serum bilirnbin reducing from 360 μmol/l to 158.2 μmol/l, postoperatively. 43 cases received hemostatic. Transient hemobilia occurred in 11 cases, and severe hemobilia in other 5 cases requiring further management. Other 4 cases needed arterial embolization with another one failure. Conclusion: Hemobilia is a complication after PTBD, which can be promptly controlled with improving skillful maneuver. (authors)

  3. Investigation on biocompatibility of biliary stent materials%胆道支架材料生物相容性的研究

    Institute of Scientific and Technical Information of China (English)

    刘恒全; 黄楠; 冷永祥; 骆乐; 于海亮; 李可洲

    2011-01-01

    The newly developed biliary stent should have good mechanical properties, as well as excellent biocompatibility in order to meet the needs of reducing immunological reaction in vivo. In this work, Ti-0 film was deposited on 316L stainless steel (316L SS) by unbalanced magnetron sputtering device, and the structure of Ti-O film was characterized by X-ray diffraction (XRD). The interaction of Ti-0 film and bile was also investigated by incubating in human fresh bile. The results showed that the surface of Ti-0 film could reduce bacteria adherence and form bacterial biofilm owing to more surface energy. The mesobilirubin reducing and the change of the stability of bile are other factors of evaluating biocompatibility. It's important to develop new biliary stent materials based on its biocompatibility.%胆道支架不仅要求具备优异的力学性能,更重要的是材料在胆道环境中具有良好的生物相容性.采用非平衡磁控溅射设备在不锈钢基体上制备了Ti-O薄膜,研究了其结构及与病人胆汁相互作用.结果表明,Ti-O膜表面具有较高的表面能,不利于细菌粘附及生物膜形成,胆汁稳定性和胆红素变化也是影响支架材料相容性的主要原因,这对开发新型胆道支架材料提供了研究依据.

  4. Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

    International Nuclear Information System (INIS)

    Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed

  5. Analysis of factors influencing recurrent occlusion of metallic stents in malignant biliary obstruction%恶性梗阻性黄疸支架再梗阻的多因素分析

    Institute of Scientific and Technical Information of China (English)

    刘长富; 郭志; 司同国; 邢文阁; 刘方; 于海鹏

    2009-01-01

    Objective To analyze the clinical and pathological factors which can influence the occurrence of the recurrent occlusion of metallic stents in patients with malignant biliary obstruction. Methods The clinical data of 50 patients with malignant biliary obstruction, who suffered repeated metallic stents obstruction and were admitted to authors" hospital during the period of March 2006-September 2008, were retrospectively analyzed. Of 50 patients, liver carcinoma was diagnosed in 12, pancreatic carcinoma in 17 and carcinoma of bile duct in 21. The relevant factors which might bear a relation to the occurrence of repeated metallic stents obstruction were evaluated. Results Single factor analysis of variance indicated that the denomination of carcinoma, clinical stage of carcinoma, location of obstruction, whether infection being accompanied or not, and the anti-tumor therapy after biliary stenting treatment were the significant factors closely linked to the occurrence of repeated metallic stents obstruction in patients with malignant biliary obstruction, Logistic regression analysis demonstrated that clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not were the important factors that determined the occurrence of repeated metallic stents obstruction. Conclusion Clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not are important reference factors for judging the occurrence of occlusion of metallic stents in malignant biliary obstruction.%目的 探讨恶性梗阻性黄疸支架置入后再梗阻的相关危险因素.方法 回顾性分析发生胆道内支架再梗阻资料完整的50例恶性梗阻性黄疸患者,分析影响胆道支架再梗阻的相关危险因素.结果 单因素分析表明原发肿瘤类型、肿瘤临床分期、梗阻部位、是否合并感染、支架治疗后是否应用抗肿瘤治疗是影响日日道支架再梗阻的相关因素;多因素分析

  6. Endoscopic management of biliary complications after liver transplantation: An evidence-based review.

    Science.gov (United States)

    Macías-Gómez, Carlos; Dumonceau, Jean-Marc

    2015-06-10

    Biliary tract diseases are the most common complications following liver transplantation (LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents (FCSEMSs) has not been demonstrated to be superior (except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients. PMID:26078829

  7. Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What's new?

    Science.gov (United States)

    Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia

    2016-02-25

    Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404

  8. Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?

    Science.gov (United States)

    Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia

    2016-01-01

    Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404

  9. 多途径置金属支架治疗晚期恶性梗阻性黄疸162例%Different approaches of metal stent placement for advanced malignant obstructive jaundice in 162 patients

    Institute of Scientific and Technical Information of China (English)

    侯森林; 乔娜; 乔占英; 康建省; 高永平; 张立超; 韩锦胜

    2011-01-01

    Objective To discuss the curative effect of different ways in metal stent placement for advanced malignant obstructive jaundice for the basis in selecting a better method in clinic. Methods Treatment on 162 cases of malignant biliary obstruction were reviewed retrospectively, whose biliary stent insertions were through endoscopic retrograde cholangiopancreatography(ERCP) ( n = 129) , percutaneous transhepatic cholangial drainage(PTCD) ( n = 25),ERCP joint PTCD ( n =8). By comparison in liver function indexes before and after operation, including total bilirubinC TBIL), direct bilirubin ( DBIL) , indrect bilirubin ( IBID , alanine amintransferase ( ALT), and aspartate transaminase(AST) ,the efficacy of three approaches were evaluated. Results Compared with before operation, TBIL, DBIL,IBIL, ALT and AST decreased one week after the stent insertion ( P 0. 05). ERCP+PTCD presented no post-operation complication, due to fewer cases. Conclusion The curative effect for different approaches of metal stent placement in treatment of advanced malignant obstructive jaundice is definite. Each method should be chosen according to the patients' condition so as to remove the jaundice and improve the liver function and the quality of life.%目的 探讨应用多途径置金属支架治疗晚期恶性梗阻性黄疸的效果,为临床上选择更适当的方法治疗晚期恶性梗阻性黄疸提供依据.方法 回顾分析162例晚期恶性梗阻性黄疸患者经内镜逆行胰胆管造影(ERCP)途径(n=129)、经皮经肝胆管引流(PTCD)途径(n=25)、联合ERCP和PTCD途径(n=8)置入金属支架治疗的情况.通过比较患者术前与术后1周肝功能指标,总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)的变化,评价3种方法的有效性.结果 术后1周复查血清生化指标,TBIL、DBIL、IBIL、ALT、AST均显著下降(P<0.01).并发症发生主要是感染、出血、胰腺炎,经治

  10. Preparation of mitomycin C-eluting stent for biliary tract%丝裂霉素C涂层胆道支架的制作

    Institute of Scientific and Technical Information of China (English)

    肖宏生; 张明明; 胡冰

    2012-01-01

    目的 制作一种带有丝裂霉素C(MMC)涂层的胆道支架,观察带药支架药物释放的规律.方法 将MMC和聚乳酸羟基乙酸(PLGA)粉末以1%的带药浓度溶于两者的共同溶剂四氢呋喃中,并将6Fr胆道引流管浸泡于上述溶剂中,10min后取出,真空烘干,常温避光保存.称量并计算支架MMC载药量.将MMC涂层支架放入8 ml磷酸盐缓冲溶液(PBS,pH 7.4)中,置于37℃的恒温摇床中持续浸泡24 h,然后换新鲜的PBS继续浸泡,重复浸泡30 d.对第1~30天留取的浸出液进行色谱分析,计算MMC在浸出液中的质量浓度.结果 称量测得每根支架上MMC的载药量为(216.20±2.04) μg,单位面积的载药量为(0.732±0.007) μg/mm2.MMC均能从支架表面持续释放,第1天的洗脱浓度为(1.81±0.06) μg/ml,第2天为(1.24±0.04) μg/ml,之后波动在0.61~0.84 μg/ml范围内,第21天后开始略降低,第30天为(0.51±0.01)μg/ml.结论 用PLGA作为药物载体能成功制备MMC涂层胆道支架,体外研究表明该药物涂层支架可持续稳定释放MMC超过30 d.%Objective To prepare a mitomycin C (MMC)-eluting stent for biliary tract, and to observe the drug delivery from the stent. Methods The mixed powder of MMC and polylactic glycolic acid (PLGA) was dissolved with their common solvent tetrahydrofuran (THF) , with a drug concentration of 1%. The 6Fr biliary stent was soaked in the above solution for 10 min, and then was subjected to vacuum drying and was stored at room temperature. Then MMC-eluting stent was weighed and the MMC load was calculated. The MMC-eluting stents were soaked in 8 ml phosphate buffered saline (PBS, pH 7. 4) and placed in a shaker at a constant temperature of 37'C for 24 h soaking; then fresh PBS was changed every day for 30 days. The leaching solutions of the 130 days were subjected to chromatographic analysis to determine the concentrations of MMC. Results MMC load on each stent was (216. 20 + 2. 04) jxg, with the load per unit area

  11. Long-term Outcomes of Percutaneous Venoplasty and Gianturco Stent Placement to Treat Obstruction of the Inferior Vena Cava Complicating Liver Transplantation

    International Nuclear Information System (INIS)

    PurposeEvaluation of long-term outcomes of venoplasty and Gianturco stents to treat inferior vena cava (IVC) obstruction after liver transplantation.MethodsWe retrospectively analyzed records from 33 consecutive adult patients referred with the intent to treat suspected IVC obstruction after liver transplantation. Treatment was performed for occlusion or stenosis with a gradient exceeding 3 mmHg. The primary treatment was venoplasty and, if refractory, Gianturco stent placement. Recurrence prompted repeat venoplasty or stent placement.ResultsOf the 33 patients, 25 (aged 46.9 ± 12.2 years) required treatment at a mean of 2.3 years (14 days to 20.3 years) after transplantation. For technically successful cases, primary treatment was venoplasty alone (14) or with stent placement (10). Technical success was 96 % (24 of 25) reflecting failure to cross one occlusion. Clinical success was 88 % (22 of 25) reflecting the technical failure and two that died of unrelated complications within 5 weeks. Cumulative primary patencies were 57.1 % at 6 months (n = 21) and 51.4 % at 1 (n = 10), 3 (n = 7), 5 (n = 6), and 7 (n = 5) years. Cumulative primary assisted patency was 95.2 % at 6 months (n = 21) and at 1 (n = 15), 3 (n = 9), 5 (n = 8), and 7 (n = 8) years. The 17 patients stented for refractory (n = 10) or recurrent (n = 7) stenosis had cumulative primary and primary assisted patencies of 86.0 and 100 %, respectively, from 6 months (n = 14) to 7 years (n = 3). No major complications occurred; one fractured stent was observed after 11.6 years.ConclusionFor IVC obstruction following liver transplantation, excellent long-term outcomes can be achieved by venoplasty and Gianturco stent placement

  12. Long-term Outcomes of Percutaneous Venoplasty and Gianturco Stent Placement to Treat Obstruction of the Inferior Vena Cava Complicating Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Lorenz, Jonathan M., E-mail: jlorenz@radiology.bsd.uchicago.edu; Beek, Darren van; Funaki, Brian; Ha, Thuong G. Van; Zangan, Stephen; Navuluri, Rakesh; Leef, Jeffery A. [University of Chicago (United States)

    2013-05-11

    PurposeEvaluation of long-term outcomes of venoplasty and Gianturco stents to treat inferior vena cava (IVC) obstruction after liver transplantation.MethodsWe retrospectively analyzed records from 33 consecutive adult patients referred with the intent to treat suspected IVC obstruction after liver transplantation. Treatment was performed for occlusion or stenosis with a gradient exceeding 3 mmHg. The primary treatment was venoplasty and, if refractory, Gianturco stent placement. Recurrence prompted repeat venoplasty or stent placement.ResultsOf the 33 patients, 25 (aged 46.9 ± 12.2 years) required treatment at a mean of 2.3 years (14 days to 20.3 years) after transplantation. For technically successful cases, primary treatment was venoplasty alone (14) or with stent placement (10). Technical success was 96 % (24 of 25) reflecting failure to cross one occlusion. Clinical success was 88 % (22 of 25) reflecting the technical failure and two that died of unrelated complications within 5 weeks. Cumulative primary patencies were 57.1 % at 6 months (n = 21) and 51.4 % at 1 (n = 10), 3 (n = 7), 5 (n = 6), and 7 (n = 5) years. Cumulative primary assisted patency was 95.2 % at 6 months (n = 21) and at 1 (n = 15), 3 (n = 9), 5 (n = 8), and 7 (n = 8) years. The 17 patients stented for refractory (n = 10) or recurrent (n = 7) stenosis had cumulative primary and primary assisted patencies of 86.0 and 100 %, respectively, from 6 months (n = 14) to 7 years (n = 3). No major complications occurred; one fractured stent was observed after 11.6 years.ConclusionFor IVC obstruction following liver transplantation, excellent long-term outcomes can be achieved by venoplasty and Gianturco stent placement.

  13. Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation.

    Science.gov (United States)

    Chang, Jae Hyuck; Lee, Inseok; Choi, Myung-Gyu; Han, Sok Won

    2016-01-28

    Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation (LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach. PMID:26819525

  14. Impotence due to external Iliac steal syndrome: Treatment with percutaneous transluminal angioplasty and stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Gur, Serkan [Sifa University, Dept. of Radiology, Izmir (Turkmenistan); Oguzkurt, Levent; Kaya, Bilal; Tekbas, Guven; Ozkan, Ugur [Baskent University, Faculty of Medicine, Dept. of Radiology, Adana (Turkmenistan)

    2013-01-15

    We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.

  15. Custom-made covered transjugular intrahepatic portosystemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia

    Energy Technology Data Exchange (ETDEWEB)

    Chlapoutaki, Chrysanthi Emmanouil; Franchi-Abella, Stephanie; Pariente, Daniele [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Department of Paediatric Radiology, Paris (France); Habes, Dalila [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Pediatric Hepatology and National Reference Center for Biliary Atresia, Paris (France)

    2009-07-15

    We report an 8-month-old girl with portal hypertension secondary to biliary atresia. The decision to treat with TIPS was made at the age of 8 months due to recurrent variceal bleeding. The procedure was carried out with a 6-mm bare stent due to her small size. Radiological follow-up with Doppler US showed gradual stenosis and finally occlusion of the stent 80 days after implantation. Revision was performed with placement of an additional 6-mm expanded polytetrafluoroethylene (e-PTFE) stent-graft that had remained patent for 9 months, proving that in small children with a portal vein diameter less than 8 mm, the combination of a bare stent and stent-graft can provide excellent results. (orig.)

  16. Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

    Energy Technology Data Exchange (ETDEWEB)

    Uflacker, A., E-mail: andreuflacker@gmail.com; Sheeran, D., E-mail: dsheeran9@gmail.com; Khaja, M., E-mail: mkhaja@mac.com [University of Virginia/Interventional Radiology (United States); Patrie, J., E-mail: jp4h@virginia.edu [UVA Health System/Radiology (United States); Elias, G., E-mail: gae2y@virginia.edu [VCU Medical Center/Radiology (United States); Saad, W., E-mail: wspikes@yahoo.com [University of Michigan Health System (United States)

    2015-06-15

    PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

  17. The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle: Long-term results in a series of 18 consecutive patients

    Directory of Open Access Journals (Sweden)

    Pasquale Gallo

    2012-01-01

    Full Text Available Background: Different surgical approaches have been described in the past to treat a trapped fourth ventricle (TFV but, unfortunately, these techniques showed a high rate of dysfunction and complications. During the last 10 years the development of neuroendoscopy has dramatically changed the outcome of these patients. Materials and Methods: We conducted a retrospective evaluation of the safety, effectiveness, and long-term outcome of endoscopic aqueductoplasty and stent placement, performed in 18 consecutive patients with symptomatic TFV through a trans-fourth ventricle approach between 1994 and 2010. Thirteen patients underwent endoscopic aqueductoplasty and stent placement and 5 patients underwent aqueductoplasty alone using a tailored suboccipital approach through the foramen of Magendie in prone or sitting position. Results: The mean age of the patients at the time of surgery was 15.2 years. All patients but 3 had a supratentorial ventriculoperitoneal shunt. Fifteen patients presented with slit supratentorial ventricles. At a mean followup of 90.8 months all patients experienced a stable clinical improvement. Only two complications were observed: A transient diplopia due to dysconjugate eye movements in one patient and a transient trochlear palsy in another one. Conclusions: Our experience and the literature review suggest that endoscopic trans-fourth ventricle aqueductoplasty and stent placement is a minimally invasive, safe, and effective technique for the treatment of TFV and should be strongly recommended, especially in patients with supratentorial slit ventricles.

  18. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

  19. A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting

    Institute of Scientific and Technical Information of China (English)

    Markus K Diener; Alexis Ulrich; Theresia Weber; Moritz N Wente; Markus W Büchler; Helmut Friess

    2005-01-01

    AIM: To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction.METHODS: A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night.Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed.RESULTS: ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital.A pylorus-preserving pancreatoduodenectomy wasperformed. Intraoperatively, bile leaked out of the transected choledochus andthe stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient.CONCLUSION:As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case.

  20. Clinical Application of Stents in Digestive Diseases

    Institute of Scientific and Technical Information of China (English)

    GUAN Yongsong

    2002-01-01

    Objective To evaluate clinical application of therapeutic stenting of digestive diseases as a new approach from conventional management. Methods 115 cases of disorders in digestive system were managed with stents clinically, 148 procedures of intervention in all. The cases were suffering from portal hypertension of cirrhosis, post - operative esophageal stricture, Stricture resulted from esophageal carcinoma, Buddi - Chari syndrome, narrowing of superior mesentery arteries and biliary tract, etc. All had had the strictured or obliterated original natural tube lumen been dilated or recanalized under the guidance of monitoring of the fluoroscope before the stent placement except those receiving TIPS needing the creation of an artificial passage within the liver to place the stent. Results Therapeutic stenting achieves clinical effects completely different from conventional internal medicine and surgery such as portal hypertension by cirrhosis with esophageal varices, megalospleen, ascites improved; jaundis relived then resided and liver function improved and appetite better in postoperative stricture of bile duct; ascites and edema of lower limbs resided in Buddi - Chari syndrom; intestininal distention disappeared, appetite and digestive function improved in stricture in superior mesentery artery; and no dysphagia and easy food intake, appetite improved in patients of stricture of postoperative esophagus and stricture resulted from esophageal carcinoma. Conclusion Therapeutic stenting is clinically unique, dramatically effective, with minor risks and worthy promoting in the management of certain digestive disorders.

  1. 聚丙交酯/乙交酯胆道支架生物降解及与宿主的相容性%Biodegradability and biocompatibility of polylactide/glycolide biliary stent

    Institute of Scientific and Technical Information of China (English)

    施纯朝; 赵晓飞; 吴晓峰

    2015-01-01

    BACKGROUND:Biliary stent is widely used in different biliary tract surgeries, and there are some defects in the use of biliary stent. OBJECTIVE:To explore the biodegradability and compatibility of polylactide/glycolide biliary stent. METHODS:The polylactide/glycolide biliary stent was prepared, and immersed in the bile. At 1, 2, 3, 4 and 5 weeks after soaking, eight experimental stents were dried and placed under the scanning electron microscope. In the sterile condition, the stent was implanted under the rat skin. At 1, 2, 3, 4, and 5 weeks after implantation, two rats were sacrificed. The stent was taken out. The appearance of the stent and muscle structure of experimental animals was observed. The gross appearance of stent was observed at different time by scanning electron microscopy. The rate of degradation was calculated. The muscle structure of experimental animal and the stent were understood. RESULTS AND CONCLUSION:At 1 week, stent shape remained almost intact, but the texture became soft;surface roughness and cracks gradual y appeared;stent wal col apse was visible. The stent was completely degraded at 5 weeks. Before degradation, the stent presented clear three-dimensional reticular structure observed by scanning electron microscopy. With the time extended, the stent surface and section corrosion became worsened. By gel permeation chromatography detection, at 1 week of implantation, the molecular mass of the stent declined rapidly, and then gradual y declined. At 2 weeks, the relative molecular mass decreased to 15 000. At 4 weeks, stent mass loss was approximately 40%. Al the experimental animals were survived, no poisoning, al ergy or heat source response. The operative wound was healed wel , and no infection occurred. By histological observation, at 5 weeks, the stent was completely degraded, with a degradation rate of 100%. Surrounding muscles recovered to a normal state. These results indicate that the polylactide/glycolide biliary stent has good

  2. The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Huang Mingsheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Shan Hong [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)]. E-mail: gzshsums@public.guangzhou.gd.cn; Jiang Zaibo [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Li Zhengran [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Zhu Kangshun [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Guan Shouhai [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Qian Jiesheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Chen Guihua [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Lu Minqiang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Yang Yang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)

    2006-12-15

    Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.

  3. RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Colyer Jr

    2012-08-01

    Full Text Available William R Colyer JrDivision of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USAAbstract: The management of renal artery stenosis (RAS remains controversial. While some evidence suggests that treatment with stent placement is beneficial, randomized trials have failed to demonstrate a significant benefit. Ongoing clinical trials should help to better define the role for stenting of RAS while avoiding limitations seen with earlier trials. When it comes to stenting for RAS, several stents have been used; however, many stents which have been used previously and which are still being used are biliary stents that are used “off-label.” These stents have typically come onto the market through the 510(k pathway. To date, a total of five stents have been approved by the United States Food and Drug Administration for use in the renal arteries. Of the five stents that have received approval, the Bridge™ Extra Support (Medtronic CardioVascular, Santa Rosa, CA and the Palmaz® (Cordis Corporation, Bridgewater, NJ stents are no longer available. Currently, the Express® SD (Boston Scientific, Natick, MA, Formula™ (Cook Medical, Bloomington, IN, and Herculink Elite® (Abbott Vascular, Santa Clara, CA stents are Food and Drug Administration approved and available for use. The Herculink Elite is the most recently approved of the renal stents, having received approval in late 2011. The Herculink Elite stent is the only cobalt chromium stent approved for use in the renal arteries. Although trial data are limited and direct comparisons among renal stents is not possible, the Herculink Elite stent has demonstrated good performance. Additionally, the design of the Herculink Elite offers some advantages that may translate into improved outcomes.Keywords: renal artery stenosis, stenting, FDA approval

  4. Basic Knowledge about Metal Stent Development

    OpenAIRE

    Jeong, Seok

    2016-01-01

    Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque marker...

  5. Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents

    International Nuclear Information System (INIS)

    To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement.

  6. Percutaneous treatment of malignant jaundice due to extrahepatic cholangiocarcinoma: covered Viabil stent versus uncovered Wallstents.

    Science.gov (United States)

    Krokidis, Miltiadis; Fanelli, Fabrizio; Orgera, Gianluigi; Bezzi, Mario; Passariello, Roberto; Hatzidakis, Adam

    2010-02-01

    To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement. PMID:19495871

  7. Preoperative biliary drainage.

    Science.gov (United States)

    Saxena, Payal; Kumbhari, Vivek; Zein, Mohamad E L; Khashab, Mouen A

    2015-01-01

    The role of preoperative biliary drainage (PBD) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate. A review of the literature using Medline, Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous) and stent types (plastic or metal) in patients with resectable disease. Preoperative biliary drainage is indicated for relief of symptomatic jaundice, cholangitis, patients undergoing neoadjuvant therapy or those patients where surgery may be delayed. Endoscopic methods are preferred over percutaneous methods because of lower complication rates. In patients with proximal biliary obstruction, PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments. PMID:25293587

  8. Changes in coronary bifurcations after stent placement in the main vessel and balloon opening of stent cells:theory and practical verification on a bench-test model

    Institute of Scientific and Technical Information of China (English)

    Dobrin Vassilev; Robert Gil

    2008-01-01

    Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main

  9. Comparison between Willis covered stent placement and coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods: Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n=43, group A) or coil embolization (n=46, group B) according to the patients' will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results: Endovascular covered stent placement and coil embolization were technically successful in all patients, except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81% , 95% CI: 69%, 93%) and 24 patients of group B (52%, 95% CI: 37%, 67%) (P< 0.05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41, 95%, 95% CI: 88%, 102%) and 22 patients of group B (22/45, 49%, 95% CI: 34%, 64%, P<0.01). The average procedure time was (103±13) min in group A and (143±39) min in group B (P<0.01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion: In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization. (authors)

  10. Treatment of upper digestive tract stricture with metal stent placement under gastroscope%内镜下金属支架置入术治疗上消化道狭窄79例疗效分析

    Institute of Scientific and Technical Information of China (English)

    李小安; 赵奎; 李晓辉; 赵微; 吴维宇

    2012-01-01

    Objective To evaluate the clinical effect of metal stent placement by gastroscope on upper digestive tract stricture and the solution of the difficulties during placement. Methods The metal stent placement was conducted by orthoptic gastroscope or gastroscope and fluoroscopic guidance. Results Metal stents were placed successfully in all patients and dysphagia was relieved. Tracheoesophageal fistula was completed closed after stent placement in 3 cases. Conclusion Metal stent placement is an effective and safe method for upper digestive tract stricture.%目的 探讨胃镜下金属支架置入术治疗上消化道狭窄的临床疗效及安全性.方法 对79例上消化道狭窄患者采用内镜直视以及X线监视与内镜直视相结合的方法放置金属支架.结果 79例患者均一次性成功放置金属支架,吞咽困难得到缓解;3例食管气管瘘得到有效封堵.结论 放置金属支架是治疗上消化道狭窄安全有效的方法,但也需注意减少、减轻并发症的发生.

  11. [Malignant biliary obstruction].

    Science.gov (United States)

    Hucl, Tomáš

    2016-01-01

    Pancreatic cancer and cholangiocarcinoma are the most common causes of malignant biliary obstruction. They are diseases of increasing incidence and unfavorable prognosis. Only patients with localized disease indicated for surgery have a chance of long-term survival. These patients represent less than 20 % of all patients, despite the progress in our diagnostic abilities.Locally advanced and metastatic tumors are treated with palliative chemotherapy or chemoradiotherapy; the results of such treatments are unsatisfactory. The average survival of patients with unresectable disease is 6 months and only 5-10 % of patients survive 5 years.Biliary drainage is an integral part of palliative treatment. Endoscopically or percutaneosly placed stents improve quality of life, decrease cholestasis and pruritus, but do not significantly improve survival. Biliary stents get occluded over time, possibly resulting in acute cholangitis and require repeated replacement.Photodynamic therapy and radiofrequency ablation, locally active endoscopic methods, have been increasingly used in recent years in palliative treatment of patients with malignant biliary obstruction. In photodynamic therapy, photosensitizer accumulates in tumor tissue and is activated 48 hours later by light of a specific wave length. Application of low voltage high frequency current during radiofrequency ablation results in tissue destruction by heat. Local ablation techniques can have a significant impact in a large group of patients with malignant biliary obstruction, leading to improved prognosis, quality of life and stent patency. PMID:26898789

  12. The application of biliary catheter folding technique in the treatment of hilar nonanastomotic biliary strictures after orthotopic liver transplantation

    International Nuclear Information System (INIS)

    Objective: To introduce a newly-designed percutaneous single catheter folding technique, by which bilateral biliary drainage and stenting can be completed through single access, and to assess the effectiveness and safety of this technique in treating hilar nonanastomotic strictures occurred after orthotopic liver transplantation. Methods: A total of 10 patients with nonanastomotic strictures, who were encountered during the period from July 2000 to July 2010 in authors' hospital, were enrolled in this study. Balloon dilatation was used for the biliary tract stenosis. After the placement of biliary drainage tube, the catheter was folded into 'Y' shape within the biliary duct at hepatic portal region, and triaxial supporting drainage, i.e. the left hepatic duct, the right hepatic duct and the common hepatic duct, was established. The technical success rate, the clinical efficacy, the complications and the recurrence were documented and analyzed. Results: Technical success rate was 100% (10/10). In 9 patients, the clinical symptoms were obviously relieved, the biochemical indexes were gradually restored to normal and the imaging findings were markedly improved. During the follow-up lasting 26 months (median), no recurrence was seen. Minor complications occurred in two cases. One patient died after he received second orthotopic liver transplantation because of failure to respond to initial treatment. Conclusion: Percutaneous transhepatic biliary catheter folding technique is technically feasible. The results of this study indicate that this technique carries satisfactory success rate and is very effective and safe for the treatment of hilar nonanastomotic strictures occurred after orthotopic liver transplantation. (authors)

  13. 博莱霉素涂层支架对胆管良性狭窄的影响%Effects of bleomycin eluting stent on benign biliary stricture

    Institute of Scientific and Technical Information of China (English)

    张庆普; 张晓; 黄涛; 赵付生; 贾廷印; 延学军

    2014-01-01

    Objective To investigate the effects of bleomycin eluting stent on benign biliary stricture.Methods Twenty-four New Zeal white rabbits with bile duct injury were randomly assigned into group A (n =12) and group B (n =12),subject to the implantation of the extrahepatic bile duct bleomycin-coated stents and ordinary stents.After 0 d and 4 weeks,the ear vein blood was taken for determination of total bilirubin,then the rabbits were sacrifaced,the papaffin-embedded sections were prepared by the implanted stents,and stained with hematoxylin and eosin (HE).The computer image detection system was used to examine the changes of gallbladder lumen areas in two groups.Fas,transforming growth factor-β1 (TGF-β1),and α-smooth muscle actin (α-SMA) antibodies were employed for immunostaining in two groups.Results Fas gene expression level in bile duct tissue of group A was significantly higher than in group B (P < 0.05).TGF-β1 and α-SMA expression levels in group A were significantly lower than in group B (P < 0.05).The extrahepatic bile duct stenosis was significantly alleviated,and liver function improved significantly in group A as compared with group B (P < 0.05).Conclusion Bleomycin enhances the expression of Fas gene in rabbit smooth muscle cells,promotes apoptosis,inhibits fibroblast activity,and decreases the deposit of collagen,resulting in the suppression of bile duct stricture,and the recovery of liver function.%目的 观察博莱霉素涂层支架对兔胆管良性狭窄的影响.方法 24只新西兰白兔行胆管损伤后平均分入A、B组,分别将博莱霉素涂层支架和普通支架植入两组兔的肝外胆管内.0d、4周后,取耳缘静脉血,检测总胆红素变化,随后处死兔,取植入支架行石蜡切片,行苏木素-伊红(HE)染色,并采用计算机图像检测系统检测两组胆管腔面积变化,同时各组切片行Fas、转化生长因子-β1(TGF-β1)、α-平滑肌肌动蛋白(α-SMA)抗体进行免疫

  14. Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

    International Nuclear Information System (INIS)

    Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

  15. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

    2016-01-15

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

  16. Effect of percutaneous transhepatic biliary drainage combined with metallic stent implantation treatment for biliary obstruction after portoenterostomy of bile duct cancer%经皮肝穿刺胆管引流术联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的疗效

    Institute of Scientific and Technical Information of China (English)

    谢军; 时启良; 郭长东; 王洪剑; 吕维富

    2015-01-01

    Objective To study the effect of clinical application of percutaneous transhepatic catheter drainage(PTCD)and metallic stents on biliary obstruction after portoenterostomy of bile duct cancer. Methods Form Nov. 2011 to May. 2014,a total of 24 patients with obstructive jaundice after portoenterostomy were admitted to the hospital and their clinical data were retrospectively analyzed. The PTCD or implantation of metallic stents was performed in 24 patients. The change of bilirubin restored,AST,ALT and the survival rate of the patients were documented and analyzed. Results The operation was successful in all 24 patients. Among 14 patients of obstruction of lower biliary tract,stent implantation was carried out in 10 patients. Among 10 patients of obstruction of higher biliary tract,stent implantation was carried out in 3 patients. The difference between the two groups was significant (P<0. 05). After the treatment,relief of jaundice symptoms was a-chieved,and the bilirubin restored to normal or acceptable lever,and hepatic function was improved obviously. The median follow-up time was 120 days. During the follow-up,death occurred in 7 cases among 11 patients while death occurred in 2 cases among 13 patients in com-bined-stents group. The difference in the survival rate between the two groups was significant statistically (P<0. 05). Conclusion PTCD or PTCD combined stents is an effective and advisable therapy for biliary obstruction after portoenterostomy of bile duct cancer. Obstruction of lower biliary tract is easier to implant stent. The technique of PTCD combined stents is superior to PTCD technique in the survival rate.%目的:探讨经皮肝穿刺胆管引流术(PTCD)联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的临床应用效果。方法回顾性分析24例胆管癌胆肠吻合术后梗阻性黄疸患者临床资料,采用经皮穿刺胆管引流(引流组)或经皮穿刺胆管引流术联合金属内支架植入

  17. 覆膜金属胆管支架在良性胆管狭窄中的应用%Role of fully covered self-expandable metal stent in treatment of benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    钱晶瑶; 李文

    2014-01-01

    自膨式金属支架(self-expandable metal stent,SEMS)通常用于缓解恶性胆管狭窄.近来,覆膜自膨式金属支架(coveredself-expandable metal stent,CSEMS)应用于良性胆管狭窄(benign biliary strictures,BBS),有延长支架通畅时间、减少内镜操作次数等优点,但是也可导致胆囊炎、支架移位、胰腺炎等并发症.因此,在精心选择的BBS病例中,可选用合适的CSEMS.这一综述主要着眼于CSEMS在BBS中的应用.

  18. Acute Cholangitis following Biliary Obstruction after Duodenal OTSC Placement in a Case of Large Chronic Duodenocutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2015-01-01

    Full Text Available Over-the-Scope Clip system, also called “Bear Claw,” is a novel endoscopic modality used for closure of gastrointestinal defect with high efficacy and safety. We present a patient with history of eosinophilic gastroenteritis and multiple abdominal surgeries including Billroth II gastrectomy complicated by a large chronic duodenocutaneous fistula from a Billroth II afferent limb to the abdominal wall. Bear Claw clip was used for closure of this fistula. The patient developed acute cholangitis one day after placement of the Bear Claw clip. Acute cholangitis due to papillary obstruction is a potential complication of Bear Claw placement at the dome of the duodenal stump (afferent limb in patient with Billroth II surgery due to its close proximity to the major papilla.

  19. Current status and evaluation of endoscopic treatment of biliary strictures%胆管狭窄内镜治疗的现状与评价

    Institute of Scientific and Technical Information of China (English)

    姚礼庆; 钟芸诗; 周嘉敏

    2012-01-01

    For the characteristics including minimal invasion,low incidence of complication and better postoperative prognosis,endoscopic therapy is widely accepted to be the first line therapy for most biliary strictures.At present,repeated progressive dilation combined with multiple plastic stents placement is the main therapy for benign biliary strictures.The long-term effective rate is relatively high in surgery related strictures,but in the non-surgery related strictures,its long-term effective rate is limited and the optimal therapy should be chosen cautiously according to patients' condition.In malignent biliary stricutes,dilation combined with metallic stents placement is recommended to treat both of preoperative long-term drainage in patients with resectable tumor and palliative treatment in patients with unresectable tumor,while nosobiliary drainage is recommended in preoperative short-term drainage. The choice of unilateral or bilateral drainage depends on patients' conditons in malignent hilar biliary strictures.The merits and demerits of stents should be mastered before they are placed in stricture sections.Recently,a lot of new endoscopic technologies and methods are applied in clinical practice,but their curative effect should be tested.Therefore,accumulative evidence-based data are needed to make them more rational and more standard.

  20. Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case

    DEFF Research Database (Denmark)

    Knop, Filip Krag; Pilsgaard, Bo; Meisner, Søren;

    2004-01-01

    condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation...... to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions...

  1. CT三维重建在胆道金属支架植入术前评估中的应用价值%Application of CT three dimensional reconstruction in preoperative evaluation of biliary metal stent implantation

    Institute of Scientific and Technical Information of China (English)

    黄汉强; 曹彭钢; 黄奕梅; 谭键彬

    2015-01-01

    Objective To investigate the value of CT three dimensional reconstruction in preoperative evaluation of biliary metal stent implantation.Methods 22 patients with obstructive jaundice in 2013 December to 2014 August in our hospital were evaluated in patients before operation by CT three-dimensional reconstruction, the implementation of biliary metal stent implantation in treatment, to observe the changes of clinical symptoms and clinical indexes of patients before and after surgery. Results To evaluate the preoperative CT 3D reconstruction of 22 patients in this group, the implementation of biliary metal stent implantation is all successful treatment of obstructive jaundice.Postoperative clinical symptoms in 3D patients were significantly improved.The postoperative serum total bilirubin in patients with 7d and serum direct bilirubin, alanine aminotransferase, the diameter of common bile duct were significantly decreased (P<0.05).All 22 cases of patients with no obvious complications.Conclusions The use of CT three-dimensional reconstruction in preoperative assessment can be given feasibility of biliary metal stent implantation of biliary metal stent diameter and length selection, intraoperative accurately predict, significantly enhance the biliary tract Stand Implantation of metal treatment, no obvious complications, worthy of application and promotion.%目的:探讨CT三维重建用于胆道金属支架植入术前的评估价值。方法选择2013年12月至2014年8月我院收治的梗阻性黄疸患者22例,在术前通过CT三维重建进行评估,实施胆道金属支架植入术治疗,观察患者术前及术后临床症状及临床指标变化。结果本组22例患者经CT三维重建术前评估,实施胆道金属支架植入术治疗梗阻性黄疸全部获得成功。术后3d患者的临床症状均明显得到好转。术后7d患者的血清总胆红素值、血清直接胆红素值、丙氨酸氨基转移酶、胆

  2. Two-year clinical outcomes after coronary drug-eluting stent placement in Chinese men and women: a multicenter, prospective registry study

    Directory of Open Access Journals (Sweden)

    Shrestha R

    2013-07-01

    Full Text Available Rajiv Shrestha,1 Sandeep Gami,1 Jing Xu,2 Du-Jiang Xie,2 Zhi-Zhong Liu,2 Tian Xu,1 Fei Ye,2 Shi-Qing Din,3 Xue-Song Qian,4 Song Yang,5 Yue-Qiang Liu,6 Feng Li,7 Ai-Ping Zhang,8 Shao-Liang Chen2 1Nanjing Medical University, Nanjing, 2Nanjing First Hospital, Nanjing Medical University, Nanjing, 3Huainan Xinhua Hospital, Huainan, 4Zhangjiagang People's Hospital, Zhangjiagang, 5Yixin People's Hospital, Yixin, 6Jintan People's Hospital, Jintan, 7Huainan Oriental General Hospital, Huainan, 8Huainan People's Hospital, Huainan, People's Republic of China Background: Previous studies have reported a discrepancy in baseline characteristics and outcomes after percutaneous coronary intervention between men and women. However, this finding has never been verified in the Chinese population. The present study analyzed two-year clinical outcomes after placement of coronary drug-eluting stents in Chinese men and women. Methods: From January 2005 to December 2010, a total of 3804 Chinese patients (2776 men, 1028 women who underwent drug-eluting stent implantation were studied prospectively. The primary endpoint was the composite major adverse cardiac event (MACE rate, including myocardial infarction, cardiac death, and target vessel revascularization at two years. Stent thrombosis served as the safety endpoint. Propensity score matching was used to compare the adjusted MACE rate between the two groups. Results: At two-year follow-up, unadjusted rates of myocardial infarction, non-ST segment elevation myocardial infarction, target vessel revascularization, and MACE were significantly different between men (6.84%, 4.6%, 13.1%, and 21.7%, respectively and women (3.8% [P = 0.001], 2.0% [P < 0.001] 10.3% [P = 0.025], and 16.3% [P < 0.001], respectively. After propensity score matching, there were no significant differences in composite MACE and individual endpoints at two years between the genders. Conclusion: Despite all the unfavorable risk factor clustering in

  3. Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation

    International Nuclear Information System (INIS)

    We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

  4. Biliary tract prosthesis combined with pancreatic duct stents in patients with periampullary carcinoma%晚期壶腹周围癌的胆胰管双支架治疗

    Institute of Scientific and Technical Information of China (English)

    韩树堂; 史伟; 张小琴; 张以洋; 张其德; 肖君; 周玉宏; 胡余美; 姜素峰

    2009-01-01

    目的 探讨晚期壶腹周围癌患者胆管和胰管双支架治疗的临床价值.方法 36例经病理学和(或)临床诊断为晚期壶腹周围癌患者,影像学表现为胰管和胆管均有狭窄,经内镜先在胰管内置入Teflon塑料支架,然后胆道内置入可膨胀式金属支架,不成功者改经皮经肝胆管内置入金属支架进行引流.观察支架置放前后患者的血清肝生化指标、胰酶水平和临床表现.结果 36例置入胰管塑料支架均顺利,29例内镜置入金属胆道支架成功,7例(2例Billroth Ⅱ术后)因导丝插入胆管困难改为经皮经肝胆管内支架置入.支架置放后肝ALT、AST、ALP、r-谷氨酰转肽酶以及总胆红素、直接胆红素均有明显的下降;15例出现血淀粉酶和血脂肪酶的升高,但经过治疗后均恢复正常;腹痛缓解率82.4%(28/34),腹泻改善有效率达88.2%(15/17).结论 胆、胰管联合支架可以解除壶腹周围癌患者的胆、胰管恶性狭窄与梗阻,安全有效.%Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after

  5. Endoscopic treatment of biliary complications after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS: This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis p erformed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography (ERCP) was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after 1 year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach (PTC) or surgery was adopted. RESULTS: From .lune 2003 to .lune 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of FRCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, 1 patient was re- transplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3 + 13.13 mo and 21.02:1:14.10 raG, respectively. CONCLUSION: Albhough ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whether other endoscopic protocols or new devices, could improve the current results.

  6. Complications and treatment of migrated biliary endoprostheses: A review of the literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.

  7. Coronary Angioplasty Stent Placement

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