title: 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.
abstract: 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.
authors.affiliation: Department of Radiological Sciences, Sapienza-University of Rome, Viale Regina Elena 324, Rome 00161, Italy. fabrizio.fanelli@uniroma1.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Orgera
authors.forename: Mario
authors.initials: M
authors.lastname: Bezzi
authors.forename: Plinio
authors.initials: P
authors.lastname: Rossi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Allegritti
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D019072:Antibiotic Prophylaxis; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D003138:Common Bile Duct Neoplasms / Q000150:complications*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications*; D011138:Polytetrafluoroethylene / Q000031:analogs & derivatives; D011183:Postoperative Complications; D011474:Prosthesis Design; D015607:Stents; D015996:Survival Rate; D005465:Fluorocarbon Polymers
chemical_list: D000497:Alloys; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; C096305:fluorinated ethylene propylene; D005465:Fluorocarbon Polymers; C013616:nitinol