BACKGROUND: Self-expanding metal stents (SEMS) are known to have a significantly higher patency rate than plastic stents. We aimed to identify prognostic factors, besides stent type, for stent patency and to develop a score model that could further aid in guiding stent choice for the palliation of a malignant biliary stricture. METHODS: A retrospective multicenter study was conducted. Data on consecutive patients who had a stent placed between January 2002 and July 2009 were collected. Cumulative stent occlusion rates were analyzed by Kaplan-Meier curves and log rank testing, and prognostic factors were assessed by Cox regression analysis. RESULTS: A total of 690 stents (512 plastic stents, 174 SEMS) were endoscopically placed in 390 patients. At 8 weeks, stent occlusion had occurred in 32% of the plastic stents and 11% of the SEMS. Multivariate analysis indicated that plastic stents (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.9-3.5), a tight stricture requiring preceding dilation (HR 1.8, 95% CI 1.3-2.5), and a high initial bilirubin level (>50 μmol/L (HR 1.3, 95% CI 1.0-1.7) were independently associated with an increased risk of stent occlusion. A score model based on these 3 factors was able to distinguish between stent procedures with a relatively high and low risk of stent occlusion (median 14 vs. 26 weeks, respectively). CONCLUSION: Besides plastic stents, stricture severity requiring preceding dilation, and initial higher bilirubin level were associated with a shorter period of stent patency. A simple score model based on these factors was able to predict stent occlusion and may aid in choosing the most appropriate stent type in individual patients.
BACKGROUND: Self-expanding metal stents (SEMS) are known to have a significantly higher patency rate than plastic stents. We aimed to identify prognostic factors, besides stent type, for stent patency and to develop a score model that could further aid in guiding stent choice for the palliation of a malignant biliary stricture. METHODS: A retrospective multicenter study was conducted. Data on consecutive patients who had a stent placed between January 2002 and July 2009 were collected. Cumulative stent occlusion rates were analyzed by Kaplan-Meier curves and log rank testing, and prognostic factors were assessed by Cox regression analysis. RESULTS: A total of 690 stents (512 plastic stents, 174 SEMS) were endoscopically placed in 390 patients. At 8 weeks, stent occlusion had occurred in 32% of the plastic stents and 11% of the SEMS. Multivariate analysis indicated that plastic stents (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.9-3.5), a tight stricture requiring preceding dilation (HR 1.8, 95% CI 1.3-2.5), and a high initial bilirubin level (>50 μmol/L (HR 1.3, 95% CI 1.0-1.7) were independently associated with an increased risk of stent occlusion. A score model based on these 3 factors was able to distinguish between stent procedures with a relatively high and low risk of stent occlusion (median 14 vs. 26 weeks, respectively). CONCLUSION: Besides plastic stents, stricture severity requiring preceding dilation, and initial higher bilirubin level were associated with a shorter period of stent patency. A simple score model based on these factors was able to predict stent occlusion and may aid in choosing the most appropriate stent type in individual patients.
Authors: Ewout W Steyerberg; Marjolein Y V Homs; Annemieke Stokvis; Marie-Louise Essink-Bot; Peter D Siersema Journal: Gastrointest Endosc Date: 2005-09 Impact factor: 9.427
Authors: G Costamagna; M Mutignani; G Rotondano; L Cipolletta; L Ghezzo; A Foco; A Zambelli Journal: Gastrointest Endosc Date: 2000-01 Impact factor: 9.427
Authors: V G Bain; N Abraham; G S Jhangri; T W Alexander; R C Henning; M E Hoskinson; C G Maguire; E A Lalor; D C Sadowski Journal: Can J Gastroenterol Date: 2000-05 Impact factor: 3.522
Authors: Y Miura; I Endo; S Togo; H Sekido; K Misuta; Y Fujii; T Kubota; K Tanaka; K Nagahori; H Shimada Journal: J Hepatobiliary Pancreat Surg Date: 2001
Authors: Marc F Catalano; Joseph E Geenen; Glen A Lehman; Jerome H Siegel; Leslie Jacob; Matthew J McKinley; Isaac Raijman; Peter Meier; Ira Jacobson; Richard Kozarek; Firas H Al-Kawas; Simon K Lo; Kulwinder S Dua; John Baille; Gregory G Ginsberg; William Parsons; Scott M Meyerson; Seth Cohen; Douglas B Nelson; James D McHattie; David L Carr-Locke Journal: Gastrointest Endosc Date: 2002-03 Impact factor: 9.427