title: Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness.
abstract: BACKGROUND
  Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum) stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile duct obstruction.
  
  
  METHODS
  In this study, 47 patients (median age, 73 years, range, 56-86 years) with inoperable malignant distal common bile duct strictures were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups. Cost-effectiveness analysis also was performed for the two study groups.
  
  
  RESULTS
  The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001).
  
  
  CONCLUSIONS
  Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases and expected short survival time.
authors.affiliation: Department of Endoscopy and Motility Unit, Central Hospital, 41 Ethnikis Aminis St., Thessaloniki, 546 35, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Katsinelos
authors.forename: D
authors.initials: D
authors.lastname: Paikos
authors.forename: J
authors.initials: J
authors.lastname: Kountouras
authors.forename: G
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: G
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: I
authors.initials: I
authors.lastname: Moschos
authors.forename: A
authors.initials: A
authors.lastname: Gatopoulou
authors.forename: A
authors.initials: A
authors.lastname: Beltsis
authors.forename: C
authors.initials: C
authors.lastname: Zavos
authors.forename: B
authors.initials: B
authors.lastname: Papaziogas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000191:economics / Q000401:mortality; D001651:Cholestasis, Extrahepatic / Q000191:economics / Q000209:etiology / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000191:economics / Q000209:etiology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000191:economics / Q000401:mortality; D015607:Stents / Q000009:adverse effects / Q000191:economics; D015996:Survival Rate
chemical_list: D008670:Metals