title: Covered Wallstents for palliation of malignant biliary obstruction: primary stent placement versus reintervention.
abstract: BACKGROUND
  Covered self-expandable metallic stents (SEMSs) are designed to prevent tumor ingrowth and can be removed if necessary. Only limited comparative data are available on the performance of covered SEMSs after primary placement versus reintervention.
  
  
  OBJECTIVE
  To assess the effectiveness and safety of covered SEMS placement either as primary treatment or reintervention in patients requiring palliation of malignant biliary obstruction.
  
  
  METHODS
  Retrospective clinical cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  This study involved 104 patients with unresectable malignant biliary strictures.
  
  
  METHODS
  Covered biliary SEMS placement.
  
  
  METHODS
  Stent patency, technical success, and patient survival.
  
  
  RESULTS
  Covered SEMSs were placed as primary treatment in 48 patients (46%), and reintervention was performed in 56 patients (54%). At 3, 6, and 12 months thereafter, the Kaplan-Meier estimated fractions of all patients with patent stents were 94%, 84%, and 58%, respectively. Covered SEMSs remained patent until the patient's death in 75 of 89 nonsurvivors (84%). Although patency rates 3, 6, and 12 months after primary placement (100%, 93%, and 82%, respectively) were higher than those after reintervention (90%, 78%, and 48%, respectively), the differences were not statistically significant (P = .057). Overall, the most frequent adverse events were cholangitis (7%) and stent migration (4%).
  
  
  CONCLUSIONS
  The distribution of stricture locations differed among the groups, and survival data suggested the presence of more extensive disease in the primary treatment group at baseline.
  
  
  CONCLUSIONS
  The clinical utility and safety of primary covered SEMS placement were confirmed. This study provides the most extensive evidence to date that reintervention with a covered SEMS can provide a useful palliative option.
authors: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors: Laura C
authors: LC
authors: Ornellas
authors: Gerasimos
authors: G
authors: Stefanidis
authors: Ram
authors: R
authors: Chuttani
authors: Andres
authors: A
authors: Gelrud
authors: T Barry
authors: TB
authors: Kelleher
authors: Douglas K
authors: DK
authors: Pleskow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000628:therapy*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D004067:Digestive System Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome