Plastic biliary stents: scratching the surface? ▸

Plastic stents remain the mainstay of endoscopic palliation of malignant obstructive jaundice but are prone to clogging with recurrence of obstruction. Strategies to prolong stent patency have been disappointing but the latest is the development of “DoubleLayer” stents, the inner lining of which contains perfluoro alkoxyl, a material similar to Teflon, along with middle mesh and outer polyamide layers. The authors, from four European centres, prospectively randomised 120 patients with inoperable malignant distal common bile duct strictures to first stenting with either the DoubleLayer stents (DLS) or standard polyethylene stents (PE). The end points were patency, occlusion or malfunction, and death. The 60 patients in each group were comparable, and at follow up 26 (43%) of the DLS patients developed clogging at a mean of 144 (11) days compared with 38 PE patients (63%) who developed clogging at 99 (9) days (p<0.05). Forty seven per cent of patients with DLS stents died without stent occlusion compared with 29% in the PE group (p<0.05), and Kaplan-Meier analysis indicated longer patency with DLS stents. These results seem good but stent patency rates in this study are not great compared with …