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- Title
No evidence of improved efficacy of covered stents over uncovered stents in percutaneous palliation of malignant hilar biliary obstruction: results of a prospective randomized trial.
- Authors
Dhondt, Elisabeth; Vanlangenhove, Peter; Geboes, Karen; Vandenabeele, Lisbeth; Van Cauwenberghe, Lien; Defreyne, Luc
- Abstract
<bold>Objective: </bold>To investigate whether covered stents show a higher efficacy than uncovered stents in percutaneous treatment of malignant hilar biliary obstruction.<bold>Methods: </bold>Patients with obstructive jaundice caused by an unresectable hilar malignancy were included after failed endoscopic intervention in a prospective randomized trial comparing expanded polytetrafluoroethylene and fluorinated ethylene propylene (ePTFE-FEP)-covered nitinol stents with uncovered nitinol stents. Exclusion criteria were as follows: primary tumors existing more than 3 months, a biliodigestive anastomosis, previous stenting, and a Karnofsky score of less than 50. Safety, clinical success, and adjuvant chemotherapy were compared as well as occlusion rate, patency, and survival.<bold>Results: </bold>A total of 120 patients were included. One patient was post hoc excluded. Fourteen patients who died within 7 days and one patient without patency data were excluded from patency analysis. Serious adverse events (p = 0.4), 30-day mortality (p = 0.5), and clinical success (p = 0.8) were equivalent for both stent groups. Twenty-one out of 61 (34%) patients in the covered and 24/58 (41%) in the uncovered stent groups received adjuvant chemotherapy (p = 0.5). Occlusion rate was 54% (27/50) in the covered stent group and 57% (31/54) in the uncovered stent group (p = 0.8). Median patency was 229 days (95% CI 113-345) for covered stents and 130 days (95% CI 75-185) for uncovered stents (p = 0.1). Median survival in patients with covered stents was 79 days (95% CI 52-106) and with uncovered stents 92 days (95% CI 60-124) (p = 0.3).<bold>Conclusion: </bold>In malignant hilar biliary obstruction, there is no evidence that ePTFE-FEP-covered stents are superior to uncovered stents in terms of safety, clinical success, adjuvant chemotherapy, patency, or survival.<bold>Key Points: </bold>• Percutaneous palliation of hilar biliary obstruction is feasible with both uncovered and covered stents. • Clinical success in terms of bilirubin decrease and adjuvant chemotherapy is achievable with both stents. • Thirty-day mortality is considerable when stenting is also offered to patients with a low performance status.
- Subjects
OBSTRUCTIVE jaundice; KARNOFSKY Performance Status; ADJUVANT treatment of cancer; DRUG-eluting stents; THERAPEUTIC use of biomedical materials; RESEARCH; LIVER tumors; CHOLESTASIS; OPERATIVE surgery; RESEARCH methodology; SURGICAL stents; EVALUATION research; MEDICAL cooperation; POLYTEF; COMPARATIVE studies; RANDOMIZED controlled trials; BILIARY tract surgery; PALLIATIVE treatment; LONGITUDINAL method; DISEASE complications
- Publication
European Radiology, 2020, Vol 30, Issue 1, p175
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06374-7