title: Management of occluded uncovered metallic stents in patients with malignant distal biliary obstructions using covered metallic stents.
abstract: BACKGROUND
  Self-expandable metallic stents (EMSs) have been widely used for the palliative treatment of unresectable malignant biliary obstructions, but EMSs are often occluded owing to tumor ingrowth via the wire mesh. Currently, there is no consensus on the management of occluded EMSs. We evaluated the efficacy of a covered EMS as a second endoprosthesis in patients with an occluded EMS.
  
  
  METHODS
  Forty patients with an occluded uncovered EMS (14 men, 26 women; mean age 72 y, range 41 to 89 y) were studied. The patients suffered from the following: pancreatic cancer in 18, bile duct cancer in 11, gallbladder cancer in 5, lymph node metastasis in 4, and papillary cancer in 2. Of these, 26, 7, and 7 were treated with a covered EMS, an uncovered EMS, and a plastic stent (PS), respectively. The second stent was inserted as a stent-in-stent.
  
  
  RESULTS
  The mean patent period for the covered EMS was 220 days, whereas the mean patent periods for the uncovered EMS and plastic stent were 141 and 58 days, respectively. The cumulative patency of the covered EMS group was significantly higher (P=0.0404) than that of the uncovered EMS group. No significant differences in survival were observed between the covered and uncovered groups. No serious complications occurred.
  
  
  CONCLUSIONS
  Insertion of a covered EMS is an effective and safe treatment for an occluded uncovered EMS.
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Saburou
authors.initials: S
authors.lastname: Matsubara
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004379:Duodenal Neoplasms / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals