Clin Endosc.  2022 May;55(3):434-442. 10.5946/ce.2021.161.

Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study

• Kitagawa K
• Mitoro A
• Ozutsumi T
• Furukawa M
• Fujinaga Y
• Seki K
• Nishimura N
• Sawada Y
• Kaji K
• Kawaratani H
• Takaya H
• Moriya K
• Namisaki T
• Akahane T
• Yoshiji H

• KMID: 2529966
• DOI: http://doi.org/10.5946/ce.2021.161

Abstract

Background/Aims
Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

Keyword

Adverse effects; Biliary tract; Self-expandable metallic stents

Figure

• 

  Fig. 1. Patient flowchart of the study. SEMS, self-expandable metallic stent; MDBO, malignant distal biliary obstruction; CMS, covered self-expandable metallic stent; UMS, uncovered self-expandable metallic stent.

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  Fig. 2. Kaplan-Meier graph showing the overall survival duration of the patients. No significant difference in the overall survival duration was observed between the laser-cut-type and braided-type CMS groups. CMS, covered self-expandable metallic stent.

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  Fig. 3. Kaplan-Meier curve showing the stent patency. Cumulative stent patency was significantly higher for the braided-type CMS than for the laser-cut-type CMS. CMS, covered self-expandable metallic stent. a)Because most patients died by the time stent dysfunction occurred, the median time for stent patency could not be calculated.

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  Fig. 4. Kaplan-Meier curve showing the cumulative patient survival without stent dysfunction. The cumulative time to stent dysfunction or patient death was significantly higher in the braided-type CMS group than in the laser-cut-type CMS group. CMS, covered self-expandable metallic stent.

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