title: Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction.
abstract: BACKGROUND
  In endoscopic biliary stenting against malignant biliary obstruction, stent blockage remains as an important problem. Stent blockage occurs as a result of bacterial adherence to the inner wall of the stent. We evaluated the stent placement above the intact sphincter of Oddi to retain the function of the sphincter of Oddi as a bacteriological barrier.
  
  
  METHODS
  Sixteen patients with malignant biliary obstruction were assessed as the patients with the stent above the intact sphincter of Oddi. Sixteen patients with malignant biliary obstruction were assessed as the patients with the conventional stent placement across the sphincter of Oddi. Tannenbaum 10-Fr. stents were used in both the groups.
  
  
  RESULTS
  The median patency periods of the stent were 255 days (25th to 75th percentiles, 212-454 days; range, 39-454 days) for the group of the stents placed above the sphincter of Oddi and 82 days (25th to 75th percentiles, 48-131 days; range, 22-196 days) for the group of the stents placed across the sphincter of Oddi, respectively, with significant difference (P = 0.0001). The occlusion rates of stents placed above and across the sphincter of Oddi were 37.5% and 93.8%, respectively, with significant difference (P = 0.0008). The dislocation rates of the stent were 0% and 6.3%, respectively (not significant).
  
  
  CONCLUSIONS
  Placement of the stent above the intact sphincter of Oddi was associated with longer stent patency and lower occlusion rate.
authors.affiliation: Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Uchida
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsutsui
authors.forename: Toru
authors.initials: T
authors.lastname: Ezaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fukuma
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamata
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kinekawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Aritomo
authors.forename: Fumi
authors.initials: F
authors.lastname: Yokoyama
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kita
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Ogawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakatsu
authors.forename: Seishiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D009803:Sphincter of Oddi; D015607:Stents; D016896:Treatment Outcome