Plastic or Metal Stents
Clinical literature reports ease of placement, clinical benefits and cost effectiveness of endoscopically-placed biliary metal stents as superior to plastic stents for most patients with unresectable biliary malignancy. 1, 2, 3, 4, 5
“Metallic stent performance was superior to plastic for hilar tumor palliation with respect to short-term outcomes, independent of disease severity, Bismuth class or drainage quality.” 1
“In endoscopic stent comparisons, metal biliary stents appear to have a lower risk of recurrent biliary obstruction that plastic stents…” 3
“The more effective [covered] SEMS are recommended in unresectable patients with malignant common bile duct strictures, who survive a median of 4.5 months.” 4
Self-Expanding Metal Stents: The success rate is in the order of 95%, due to the ease of placement.” 7
Covered or Uncovered Metal Stents
“…covered SEMS offer superior patency compared with uncovered stents.” 4
“…the present data clearly suggest that covered stents overcome tumor ingrowth and reduce the rate of stent occlusion. Furthermore, the covered metal stent significantly reduced the number of reinterventions. It may contribute to improvement in quality of life of patients. Consequently, the total cost was also significantly smaller in the covered group.” 7
References
1 Perdue D, Freeman M, DiSario J et al. Plastic Versus Selfexpanding
Metallic Stents for Malignant Hilar Biliary Obstruction Journal of Clinical Gastroenterology, October 2008; 42: 1040-1046.
2 Kassis et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. GI Endoscopy
2003; 57: 178-182.
3 Moss A.; Morris E., MacMathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Systematic Review; 25 Jan. 2006.
4 Kahaleh M., Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointestinal Endoscopy, 2005; 61: 528-533.
5 Soderlund K., Linder S.Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointestinal Endoscopy; 2006; 63: 986-995.
6 Rey JF et al.; Guidelines of the French Society of Digestive Endoscopy: Biliary Stenting. Endoscopy 2002; 34: 169-173.
7 Isayama H., KomatsuY.,TsujinoT., Sasahira N., Hirano K.,Toda N, et al. A prospective randomized study of “covered” versus “uncovered” diamond stents for the management of distal
malignant biliary obstruction. Gut 2004; 53: 729-734.
The safety and effectiveness of this device for use in the vascular system has not been established.
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