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  • Title: Novel antireflux covered metal stent for recurrent occlusion of biliary metal stents: a pilot study.
    Author: Hamada T, Isayama H, Nakai Y, Kogure H, Togawa O, Kawakubo K, Yamamoto N, Ito Y, Sasaki T, Tsujino T, Sasahira N, Hirano K, Tada M, Koike K.
    Journal: Dig Endosc; 2014 Mar; 26(2):264-9. PubMed ID: 23621525.
    Abstract:
    BACKGROUND: Feasibility of antireflux metal stent (ARMS), designed to prevent duodenobiliary reflux, was reported in patients with distal malignant biliary obstruction. In this prospective pilot study, we aimed to evaluate a newly designed ARMS as a reintervention for self-expandable metallic stent (SEMS) occlusion believed to be caused by duodenobiliary reflux. PATIENTS AND METHODS: Patients with non-resectable distal malignant biliary obstruction were included in whom a prior SEMS was occluded as a result of sludge or food impaction between March 2010 and January 2012 at two Japanese tertiary referral centers. The occluded SEMS were endoscopically removed, if possible, and subsequently replaced by a newly designed ARMS. We evaluated the technical success rate and complications of ARMS and compared the time to occlusion of ARMS with that of prior SEMS. RESULTS: A total of 13 patients were included. ARMS was successfully placed in all patients in a single procedure. No procedure-related complications were identified. ARMS occlusion occurred in two patients (15%), the causes of which were sludge in one patient and unknown in the other. ARMS migration occurred in four patients (31%). ARMS patency time was significantly longer than that of prior SEMS (median, not available vs 58 days; P = 0.039). CONCLUSIONS: This newly designed ARMS is a technically feasible, safe, and effective reintervention for SEMS occlusion as a result of sludge or food impaction. An anti-migration mechanism to improve the outcomes of ARMS should be considered.
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