%0 Journal Article
%T Efficacy of the New Double-Layer Stent for Unresectable Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study
%A Ken Ito
%A Yoshinori Igarashi
%A Takahiko Mimura
%A Yui Kishimoto
%A Yoshinori Kikuchi
%A Naoki Okano
%J Diagnostic and Therapeutic Endoscopy
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/680963
%X Background and Aims. For distal malignant biliary obstruction in cases with short life expectancy, occlusion of plastic stents (PSs) does not usually occur before death, and the application of such a procedure is considered adequate from the viewpoint of cost-effectiveness. Methods and Setting. A new commercially available DLS with side holes, a conventional DLS, and, uncovered self-expanding metal stents (SEMSs) were retrospectively evaluated in patients with jaundice due to unresectable distal malignant biliary obstruction. Results. A total of 64 patients received endoscopic biliary stenting (23 patients with the new DLS, 24 patients with conventional DLS, and 17 patients with uncovered SEMS) from December 2002 to August 2009. Median patency time was found to be 198 days for the new DLS group and 99 days for the conventional DLS group, revealing a significant difference between devices. There was, however, no significant difference in median patency time between the new DLS and the uncovered SEMS (198 days versus 344 days). Conclusion. The new DLS is efficient and safe and may be considered the first choice for unresectable distal malignant obstruction in cases with short life expectancy. 1. Introduction Endoscopic biliary stenting is a well-established method, and endoscopic palliation of malignant jaundice can improve patient quality of life. Two types of biliary stents, each of a different material, are routinely used: plastic stents (PSs) and self-expanding metal stents (SEMSs), and it is necessary for each stent to be appropriately selected for each case. SEMSs have a longer patency period than plastic stents. However, uncovered SEMSs (UMSs) also have several drawbacks, including higher cost, irretrievability once placed, and susceptibility to tumor overgrowth and ingrowth, which may result in stent dysfunction [1]. PSs on the other hand are less expensive and remain a popular alternative to metallic stents. Their major drawback, however, is their propensity to clog, often necessitating repeated stent changes in order to maintain biliary drainage [2]. To prolong the duration of PSs patency, a double-layer stent (DLS; Olympus Medical Systems, Tokyo, Japan) has been developed and shown to be superior to regular PSs with respect to patency and is consequently being used more frequently than PSs [3]. When bending of the malignant bile duct is advanced, the tip of the stent impacts the biliary wall, and since the stent has an orifice only in the tip, this situation leads to an early occlusion of DLS and becomes a major issue [3, 4]. To handle this
%U http://www.hindawi.com/journals/dte/2012/680963/