Abstract
Background: Metal stents are frequently used to manage malignant biliary strictures. Nitinol eliminates the foreshortening characteristic of stainless steel and provides better stricture conformity. Methods: Retrospective review of all first time stainless steel (Wallstent™) and nitinol (Flexxus™) uncovered metal biliary stents placed at tertiary cancer center between 1-06 to 10-07. Results: A total of 82 nitinol (7 multiple) and 96 stainless steel (8 multiple) stents were placed. The most common cancer diagnosis was pancreatic (70.2%) with the most frequent site of stricture in the common bile duct (79.8%). Stent diameter was 10 mm in 90% of cases. Biliary decompression was achieved or maintained in 75 (91.5%) nitinol and 84 (87.5%) stainless steel stents. Immediate stent manipulation was required in 4 cases of each group for either poor drainage or position. Subsequent intervention for inadequate biliary drainage was performed in 17 (20.7%) nitinol and 25 (26%) stainless steel stents at an average length of time of 131.5 (5-541) and 147.4 (14-375) days respectively. See table 1 and 2. Early complications included cholecystitis and pancreatitis: 3.6% nitinol and 5.2% stainless steel. A total of 90% received chemotherapy and 38% radiation therapy. One patient with duodenal wall adenocarcinoma and nitinol stent developed a fistula after chemoradiation which was managed surgically. Conclusion: Comparable performance and outcomes were achieved between nitinol and stainless steel stents. No perforation or fistulous complications were observed in pancreatic cancer patients receiving radiation therapy with metal stents. Efficacy in complex hilar strictures and other factors such as cost and delivery system require further evaluation in determining which stent to use. Table 1Number of Patients Requiring Stent Revision or Intervention Nitinol (%) Stainless Steel (%) Total 17 25 Before Death 9 of 24 (38) 9 of 42 (21) Before Surgery 2 of 8 (25) 2 of 11 (18) Active Observation all 6 of 50 (12) 14 of 43 (33) Active Obs after 30 days 5 of 38 (13) 14 of 37 (38) Open table in a new tab Table 2Average Duration of Stent Patency in Days (range) Nitinol Stainless Steel Total 123.1 (0-541) 140.7 (0-623) Pancreas Cancer only 124.4 153.5 CBD strictures only 132.8 152.7 Before Death 162.0 (5-541) 127.1 (1-578) Before Surgery 74.8 (7-216) 139.5 (56-283) Active Observation All 112.9 (0-431) 154.3 (0-623) Active Obs after 30 days 144.6 (42-431) 177.5 (30-623) Open table in a new tab
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