Drug-eluting stent in malignant biliary obstruction.
BACKGROUND
In unresectable malignant bile duct obstruction, endoscopic stent insertion is the treatment of choice. However, the current stent allows only mechanical palliation of the obstruction, and has no anti-tumor effect. Currently, in the vascular field, the drug-eluting stent (DES) is very highly favored.


METHODS
The requirements for a DES in a non-vascular tract, such as the bile duct, are far different from those of a DES to be used in the vascular tract. The non-vascular DES must suppress tumor proliferation as well as mucosal hyperplasia. For example, the non-vascular stent might be covered with a membrane that gradually releases a chemo-agent. We do not have much experience with DES in the bile duct. Nonetheless, we are continuously testing many anti-tumor agents in animal and human studies.


CONCLUSIONS
We expect and hope DES will work effectively for tumor cells in diverse ways and, more importantly, will prolong stent patency and the patients' survival periods. But considerable investigation and a clinical study of DES will be required to achieve these goals.
Lee
Dong Ki
DK
Department of Internal Medicine, Kangnam Hospital, Yonsei University, P.O. Box 1217, Kangnam, Seoul, Korea. dklee@yuhs.ac
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation; D002779:Cholestasis / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D054855:Drug-Eluting Stents; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome
D000970:Antineoplastic Agents