Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Parker SL, Tong T, Bolden S et al (1996) Cancer statistics CA. Cancer J Clin 46:5–27

    Article  CAS  Google Scholar 

  2. Nakeeb A, Pitt HA, Sohn TA et al (1996) Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224:463–473

    Article  CAS  PubMed  Google Scholar 

  3. Ishak KG, Anthony PP, Sobin LH (1994) Histological typing of tumors of the liver. World Health Organization, Springer-Verlag, Berlin, pp 37–45

    Google Scholar 

  4. Carriaga MT, Henson DE (1995) Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 75:171–190

    Article  CAS  PubMed  Google Scholar 

  5. Shaib Y, El-Serag HB (2004) The epidemiology of cholangiocarcinoma. Semin Liver Dis 24:115–125

    Article  PubMed  Google Scholar 

  6. Lee KH, Lee DY, Kim KW (2004) Biliary intervention for cholangiocarcinoma. Abdom Imaging 29:581–589

    Article  PubMed  Google Scholar 

  7. Hatzidakis A, Adam A (2003) The interventional radiological management of cholangiocarcinoma. Clin Radiol 58:91–96

    Article  CAS  PubMed  Google Scholar 

  8. Chahal P, Baron T (2006) Endoscopic palliation of cholangiocarcinoma. Curr Opin Gastroenterol 22:551–560

    Article  PubMed  Google Scholar 

  9. Kaassis M, Boyer J, Dumas R et al (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57:178–182

    Article  PubMed  Google Scholar 

  10. Rossi P, Bezzi M, Salvatori FM et al (1997) Clinical experience with covered Wallstents for biliary malignancies: 23-month follow-up. CardioVasc Interv Radiol 20:441–447

    Article  CAS  Google Scholar 

  11. Hausegger KA, Thurnher S, Bodendorfer G et al (1998) Treatment of malignant biliary obstruction with polyurethane covered Wallstents. AJR Am J Roentgenol 170:403–408

    CAS  PubMed  Google Scholar 

  12. Miyayama S, Matsui O, Terayama T et al (1997) Covered Gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol 8:641–648

    Article  CAS  PubMed  Google Scholar 

  13. Han YM, Jin GY, Lee S et al (2003) Flared polyurethane-covered self expandable nitinol stent for malignant biliary obstruction. J Vasc Interv Radiol 14:1291–1301

    PubMed  Google Scholar 

  14. Kanasaki S, Furukawa A, Kane T et al (2000) Polyurethane-covered nitinol Strecker stents as primary palliative treatment of malignant biliary obstruction. CardioVasc Interv Radiol 23:114–120

    Article  CAS  Google Scholar 

  15. Isayama H, Komatsu Y, Tsujino T et al (2002) Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc 55:366–370

    Article  PubMed  Google Scholar 

  16. Isayama H, Komatsu Y, Tsujino T et al (2004) A prospective randomized study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 53:729–734

    Article  CAS  PubMed  Google Scholar 

  17. Schoder M, Rossi P, Uflacker R et al (2002) Malignant biliary obstruction: treatment with ePTFE/FEP-covered endoprostheses-initial technical and clinical experiences in a multicenter trial. Radiology 225:35–42

    Article  PubMed  Google Scholar 

  18. Bezzi M, Zolovkins A, Cantisani V et al (2002) New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol 13:581–589

    Article  PubMed  Google Scholar 

  19. Hatzidakis A, Krokidis M, Kalbakis K et al (2007) ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease: Can tumor ingrowth be prevented? Cardiovasc Interv Radiol 30:950–958

    Article  Google Scholar 

  20. Fanelli F, Orgera G, Bezzi M et al (2008) Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience. Eur Radiol 18(5):911–919

    Article  PubMed  Google Scholar 

  21. WHO (1979) WHO handbook for reporting results of cancer treatment. World Health Organization, Geneva

    Google Scholar 

  22. Kuo MD, Lopresti DC, Gover DD et al (2006) Intentional retrieval of viabil stent-grafts from the biliary system. J Vasc Interv Radiol 17:389–397

    PubMed  Google Scholar 

  23. Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:199–202

    Google Scholar 

  24. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  25. Nakajima T, Kondo Y, Miyazaki M et al (1988) A histopathologic study of 102 cases of intrahepatic cholangiocarcinoma: histologic classification and mode of spreading. Hum Pathol 19:1228–1234

    Article  CAS  PubMed  Google Scholar 

  26. De Groen PC, Gores GJ, LaRusso NF et al (1999) Biliary tract cancers. N Engl J Med 341:1368–1378

    Article  PubMed  Google Scholar 

  27. Yamamoto M, Takasaki K, Yoshikawa T et al (1998) Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma? J Surg Oncol 69:162–167

    Article  CAS  PubMed  Google Scholar 

  28. Isaji S, Kawarada Y, Taoka H et al (1999) Clinicopathological features and outcome of hepatic resection for intrahepatic cholangiocarcinoma in Japan. J Hepatobiliary Pancreat Surg 6:108–116

    Article  CAS  PubMed  Google Scholar 

  29. Tsao JI, Nimura Y, Kamiya J et al (2000) Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg 232:166–174

    Article  CAS  PubMed  Google Scholar 

  30. Cameron JL, Pitt HA, Zinner MJ et al (1990) Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 159:91–98

    Article  CAS  PubMed  Google Scholar 

  31. Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38

    CAS  PubMed  Google Scholar 

  32. Baer HU, Stain SC, Dennison AR et al (1993) Improvements in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 217:20–27

    Article  CAS  PubMed  Google Scholar 

  33. Allen PJ, Reiner AS, Gonen M et al (2008) Extrahepatic cholangiocarcinoma: a comparison of patients with resected proximal and distal lesions. HPB (Oxford) 10:341–346

    Google Scholar 

  34. Nakeeb A, Tran KQ, Black MJ et al (2002) Improved survival in resected biliary malignancies. Surgery 132:555–563

    Article  PubMed  Google Scholar 

  35. Prat F, Chapat O, Ducot B et al (1998) Predictive factors for survival of patients with inoperable malignant distal biliary strictures: a practical management guideline. Gut 42:76–80

    Article  CAS  PubMed  Google Scholar 

  36. Kahaleh M, Tokar J, Conaway MR et al (2005) Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc 61:528–533

    Article  PubMed  Google Scholar 

  37. Krokidis ME, Hatzidakis AA, Manousaki EG et al (2008) Late migration of two covered biliary stents through a spontaneous bilioenteric fistula in a patient with malignant biliary obstruction. Cardiovasc Interv Radiol 31:222–225

    Article  Google Scholar 

  38. Tham TC, Carr-Locke DL, Vandervoort J et al (1998) Management of occluded biliary Wallstents. Gut 42:703–707

    CAS  PubMed  Google Scholar 

  39. Lammer J, Hausegger KA, Fluckiger F et al (1996) Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 201:167–172

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital of Heraklion, Stavrakia-Voutes, 71500, Heraklion, Crete, Greece

    Miltiadis Krokidis

  2. Department of Radiological Sciences, “La Sapienza” University of Rome, Rome, Italy

    Fabrizio Fanelli, Gianluigi Orgera, Mario Bezzi & Roberto Passariello

  3. Medical School of Crete, Heraklion, Crete, Greece

    Adam Hatzidakis

Authors
  1. Miltiadis Krokidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianluigi Orgera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Bezzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Passariello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adam Hatzidakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miltiadis Krokidis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krokidis, M., Fanelli, F., Orgera, G. et al. Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents. Cardiovasc Intervent Radiol 33, 97–106 (2010). https://doi.org/10.1007/s00270-009-9604-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-009-9604-9

Keywords

Search

Navigation