4655 Preliminary results of the new membrane covered self-expandable nitinol biliary metal stent.

Abstract

BACKGROUND: Endoscopic stenting is the method of choice to relieve obstructive jaundice in patients with nonresectable malignant biliary obstruction. A membrane covered, self-expandable metal stent has a tendency towards better long-term patency than an uncovered metal stent, and additionally prevents tumor ingrowth into the stent. Recently, we developed a more advanced membrane covered metal stent to improve the expandability, and delivery of the stent. AIM: To evaluate the success and the effectiveness of the newly developed membrane-covered self-expandable nitinol biliary metal stent. MATERIALS AND METHODS: 15 patients of malignant biliary obstruction (male 10, female 5; age 39-74 years, mean 63.7 years; cholangiocarcinoma 8, pancreatic head cancer 5, gallbladder cancer 2) were treated by endoscopic biliary endoprosthesis using the new membrane covered self-expandable nitinol biliary metal stent (Shim-Hanarostent™). The new nitinol stent (30 Fr.) having a migration preventive portion, was covered by a polyurethane membrane and had a each mesh very small size. All patients underwent papillotomy and the stent was inserted using TJF-200 duodenoscopy. A pusher tube (9.5 Fr.) and introducer sheath (11.5 Fr.) were used as stent introducer. An exchange of stent was done, if the stent malfunctioned. RESULTS: The stent deployment was successful in all 15 cases. Early complication was occurred 1 case of pancreatitis, 1 case of cholangitis. Stent occlusion occurred in 3 cases (2 cases of sludge, 1 case of tumor overgrowth). Reinsertion of the membrane covered stent after removal of an occluded stent was successful in 2 cases. One case underwent the insertion of a polyethylene stent through the occluded metal stent. CONCLUSIONS: The new membrane covered self-expandable nitinol biliary metal stent (Shim- Hanarostent™) is easy to insert and remove, and provides improved patency for patients with malignant biliary strictures. BACKGROUND: Endoscopic stenting is the method of choice to relieve obstructive jaundice in patients with nonresectable malignant biliary obstruction. A membrane covered, self-expandable metal stent has a tendency towards better long-term patency than an uncovered metal stent, and additionally prevents tumor ingrowth into the stent. Recently, we developed a more advanced membrane covered metal stent to improve the expandability, and delivery of the stent. AIM: To evaluate the success and the effectiveness of the newly developed membrane-covered self-expandable nitinol biliary metal stent. MATERIALS AND METHODS: 15 patients of malignant biliary obstruction (male 10, female 5; age 39-74 years, mean 63.7 years; cholangiocarcinoma 8, pancreatic head cancer 5, gallbladder cancer 2) were treated by endoscopic biliary endoprosthesis using the new membrane covered self-expandable nitinol biliary metal stent (Shim-Hanarostent™). The new nitinol stent (30 Fr.) having a migration preventive portion, was covered by a polyurethane membrane and had a each mesh very small size. All patients underwent papillotomy and the stent was inserted using TJF-200 duodenoscopy. A pusher tube (9.5 Fr.) and introducer sheath (11.5 Fr.) were used as stent introducer. An exchange of stent was done, if the stent malfunctioned. RESULTS: The stent deployment was successful in all 15 cases. Early complication was occurred 1 case of pancreatitis, 1 case of cholangitis. Stent occlusion occurred in 3 cases (2 cases of sludge, 1 case of tumor overgrowth). Reinsertion of the membrane covered stent after removal of an occluded stent was successful in 2 cases. One case underwent the insertion of a polyethylene stent through the occluded metal stent. CONCLUSIONS: The new membrane covered self-expandable nitinol biliary metal stent (Shim- Hanarostent™) is easy to insert and remove, and provides improved patency for patients with malignant biliary strictures.