Stenting and interventional radiology for obstruct

Authors: Toshio Tsuyuguchi Tadahiro Takada Masaru Miyazaki Shuichi Miyakawa Kazuhiro Tsukada Masato Nagino Satoshi Kondo Junji Furuse Hiroya Saito Masafumi Suyama Fumio Kimura Hideyuki Yoshitomi Satoshi Nozawa Masahiro Yoshida Keita Wada Hodaka Amano Fumihiko Miura

Publish Date: 2008/02/16

Volume: 15, Issue: 1, Pages: 69-

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Abstract

Together with biliary drainage which is an appropriate procedure for unresectable biliary cancer biliary stent placement is used to improve symptoms associated with jaundice Owing to investigations comparing percutaneous transhepatic biliary drainage PTBD surgical drainage and endoscopic drainage many types of stents are now available that can be placed endoscopically The stents used are classified roughly as plastic stents and metal stents Compared with plastic stents metal stents are of large diameter and have longterm patency although they are expensive For this reason the use of metal stents is preferred for patients who are expected to survive for more than 6 months whereas for patients who are likely to survive for less than 6 months the use of plastic stents is not considered to be improper Obstruction in a metal stent is caused by a tumor that grows within the stent through the mesh interstices To overcome such problems a covered metal stent was developed and these stents are now used in patients with malignant distal biliary obstruction However this type of stent has been reported to have several shortcomings such as being associated with the development of acute cholecystitis and stent migration In spite of these shortcomings evidence is expected to demonstrate its superiority over other types of stentMore than 20 years have passed since stents began to be used for treating unresectable bile duct stricture in patients with obstructive jaundice Previously percutaneous transhepatic cholangial drainage PTCD also known as percutaneous transhepatic biliary drainage PTBD was employed for patients with this disease and the patients were often forced to stay in hospital for a long period of time with an external biliary fistula The creation of an internal fistula is now widely used because it is as useful as surgical bypass in improving not only quality of life QOL but also survival rates Today noninvasive endoscopic stent placement is being used for most patients with this disease as an alternative procedure to the percutaneous approach Plastic stents PS which have been used until now are economical but their shortcoming is that they give rise to obstruction at an earlier stage so several improvements have been made On the other hand metal stents MS in which the insertion of the stents is enabled with a slender delivery system and the stents expand to a large diameter by themselves have conferred noticeably extended patency compared with PS However their shortcomings are that they are more expensive than PS and replacing them is difficult once they have been placed

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