Elsevier

The Lancet

Volume 340, Issues 8834–8835, 26 December 1992, Pages 1488-1492
The Lancet

ORIGINAL ARTICLES
Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction

https://doi.org/10.1016/0140-6736(92)92752-2Get rights and content

Abstract

Self-expanding metal stents are claimed to prolong biliary-stent patency, although no formal comparative trial between plastic and expandable stents has been done. In a prospective randomised trial, we assigned 105 patients with irresectable distal bile-duct malignancy to receive either a metal stent (49) or a straight polyethylene stent (56). Median patency of the first stent was significantly prolonged in patients with a metal stent compared with those with a polyethylene stent (273 vs 126 days; p=0·006). The major cause of stent dysfunction was tumour ingrowth in the metal-stent group and sludge deposition in the polyethylene-stent group. Treatment after any occlusion included placement of a polyethylene stent. In the metal-stent group none of 14 second stents occluded, whereas 11 of 23 (48%) second stents clogged in the polyethylene-stent group (p=0·002). Overall median survival was 149 days and did not differ significantly between treatment groups. Incremental cost-effectiveness analysis showed that intial placement of a metal stent results in a 28% decrease of endoscopic procedures. Self-expanding metal stents have a longer patency than polyethylene stents and offer adequate palliation in patients with irresectable malignant distal bile-duct obstruction.

References (31)

  • Re Hermann et al.

    Current concepts in cancer. Cancer of the pancreas

    N Engl J Med

    (1979)
  • Mg Sarr et al.

    Surgical management of unresectable carcinoma of the pancreas

    World J Surg

    (1984)
  • Js Dooley et al.

    Percutaneous transhepatic endoprosthesis for bile duct obstruction

    Gastroenterology

    (1984)
  • Ha Shepard et al.

    Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial

    Br J Surg

    (1988)
  • Jr Andersen et al.

    Randomized trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice

    Gut

    (1989)
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