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  • Title: Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center.
    Author: Rogart JN, Boghos A, Rossi F, Al-Hashem H, Siddiqui UD, Jamidar P, Aslanian H.
    Journal: Gastrointest Endosc; 2008 Oct; 68(4):676-82. PubMed ID: 18561919.
    Abstract:
    BACKGROUND: A significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management. OBJECTIVE: Our purpose was to review the management and outcomes of patients with biliary SEMS occlusion. DESIGN AND SETTING: Retrospective chart review at a single tertiary care hospital. PATIENTS: From January 1999 to October 2005, a total of 90 patients had SEMSs placed for malignant biliary obstruction, and 27 of these occluded. MAIN OUTCOME MEASUREMENTS: Technical success of treating SEMS occlusion, stent patency and need for reintervention, and incremental cost analysis. RESULTS: A total of 60 ERCPs were performed to treat SEMS occlusions in 27 patients. The success rate was 95%; however, 52% of patients eventually required more than 1 intervention. Placing a second SEMS through the existing SEMS (n = 14) provided the lowest reocclusion rate (43% vs 55% and 100%), the longest time to reintervention (172 days vs 66 and 43 days, P = .03), and a trend toward longer survival (285 days vs 188 and 194 days) compared with plastic stent and mechanical balloon cleaning, respectively. Incremental cost analysis showed both uncovered SEMSs and plastic stents to be cost effective strategies. LIMITATIONS: Small number of patients, retrospective study. CONCLUSIONS: Treatment of biliary SEMS occlusion with SEMS insertion provides for longer patency and survival, decreases the number of subsequent ERCPs by 50% compared with plastic stents, and is cost-effective.
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