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Novel antireflux covered metal stent for recurrent occlusion of biliary metal stents: A pilot study
Author(s) -
Hamada Tsuyoshi,
Isayama Hiroyuki,
Nakai Yousuke,
Kogure Hirofumi,
Togawa Osamu,
Kawakubo Kazumichi,
Yamamoto Natsuyo,
Ito Yukiko,
Sasaki Takashi,
Tsujino Takeshi,
Sasahira Naoki,
Hirano Kenji,
Tada Minoru,
Koike Kazuhiko
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12112
Subject(s) - medicine , occlusion , impaction , stent , surgery , reflux , radiology , disease
Background Feasibility of antireflux metal stent ( ARMS ), designed to prevent duodenobiliary reflux, was reported in patients with distal malignant biliary obstruction. In this prospective pilot study, we aimed to evaluate a newly designed ARMS as a reintervention for self‐expandable metallic stent ( SEMS ) occlusion believed to be caused by duodenobiliary reflux. Patients and Methods Patients with non‐resectable distal malignant biliary obstruction were included in whom a prior SEMS was occluded as a result of sludge or food impaction between M arch 2010 and J anuary 2012 at two J apanese tertiary referral centers. The occluded SEMS were endoscopically removed, if possible, and subsequently replaced by a newly designed ARMS . We evaluated the technical success rate and complications of ARMS and compared the time to occlusion of ARMS with that of prior SEMS . Results A total of 13 patients were included. ARMS was successfully placed in all patients in a single procedure. No procedure‐related complications were identified. ARMS occlusion occurred in two patients (15%), the causes of which were sludge in one patient and unknown in the other. ARMS migration occurred in four patients (31%). ARMS patency time was significantly longer than that of prior SEMS (median, not available vs 58 days; P = 0.039). Conclusions This newly designed ARMS is a technically feasible, safe, and effective reintervention for SEMS occlusion as a result of sludge or food impaction. An anti‐migration mechanism to improve the outcomes of ARMS should be considered.