Education in reliability engineering

Abstract

In this retrospective multicenter study, the authors analyzed the clinical efficacy of different metallic stents in the palliative treatment of patients with neoplastic obstructive jaundice.Two hundred forty patients were treated in four European centers. Causes of obstruction were pancreatic carcinoma (n = 84), biliary neoplasm (n = 99), metastases in hilar nodes (n = 34), primary or secondary liver tumors (n = 4), and other tumors (n = 19). A total of 388 metallic stents were used: 300 Wallstents, 35 nitinol Strecker stents, 40 Gianturco-Rosch Z stents, and 13 tantalum Strecker stents.Overall 25- and 50-week survival rates were 42% and 16%, respectively; the 30-day mortality rate was 14.6%. Two deaths were related to the procedure (0.8%); 19 patients (8%) had major complications. The 25-week patency rate was significantly higher for the nitinol Strecker stents and the Wallstents (78% and 67%, respectively) than for the Z stents and the tantalum Strecker stents (30% and 20%, respectively) (P < .01 and P < .001, respectively). Average patency was 8.3, 5.9, 2.3, and 4.0 months, respectively. Reintervention due to stent obstruction was necessary in 53 patients.The Wallstent and the nitinol Strecker stents were the most effective in achieving long-term palliation. Patency was significantly affected by the level of obstruction but not by the type of obstructing tumor.