A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction - 24/08/11
Reprint requests: Jennifer J. Telford, MD, MPH, FRCPC, Clinical Assistant Professor of Medicine, University of British Columbia, Pacific Gastroenterology Associates, 770-1190 Hornby Street, Vancouver, BC, Canada V6Z 2K5Résumé |
Background |
The most common complication of uncovered biliary self-expandable metal stents (SEMSs) is tumor ingrowth. The addition of an impenetrable covering may prolong stent patency.
Objective |
To compare stent patency between uncovered and partially covered SEMSs in malignant biliary obstruction.
Design |
Multicenter randomized trial.
Setting |
Four teaching hospitals.
Patients |
Adults with inoperable distal malignant biliary obstruction.
Interventions |
Uncovered or partially covered SEMS insertion.
Main outcome measures |
Time to recurrent biliary obstruction, patient survival, serious adverse events, and mechanism of recurrent biliary obstruction.
Results |
From October 2002 to May 2008, 129 patients were randomized. Recurrent biliary obstruction was observed in 11 of 61 uncovered SEMSs (18%) and 20 of 68 partially covered SEMSs (29%). The median times to recurrent biliary obstruction were 711 days and 357 days for the uncovered and partially covered SEMS groups, respectively (P = .530). Median patient survival was 239 days for the uncovered SEMS and 227 days for the partially covered SEMS groups (P = .997). Serious adverse events occurred in 27 (44%) and 42 (62%) patients in the uncovered and partially covered SEMS groups, respectively (P = .046). None of the uncovered and 8 (12%) of the partially covered SEMSs migrated (P = .0061).
Limitations |
Intended sample size was not reached. Allocation to treatment groups was unequal.
Conclusions |
There was no significant difference in time to recurrent biliary obstruction or patient survival between the partially covered and uncovered SEMS groups. Partially covered SEMSs were associated with more serious adverse events, particularly migration. (Clinical trial registration number: NCT01047332.)
Le texte complet de cet article est disponible en PDF.Abbreviations : CI, IQR, SD, SEMS
Plan
| DISCLOSURE: The following author received an Outcomes and Effectiveness Award from the American Society for Gastrointestinal Endoscopy: J. J. Telford. The following authors received an unrestricted grant from Boston Scientific Corporation, Natick, Massachusetts, USA: D. L. Carr-Locke and T. H. Baron. Boston Scientific provided the paper case report forms and a web-based data collection tool. All other authors disclosed no financial relationships relevant to this publication. |
Vol 72 - N° 5
P. 907-914 - novembre 2010 Retour au numéro
Article précédent
- Information for readers
- Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- Eric Kullman, Farshad Frozanpor, Claes Söderlund, Stefan Linder, Per Sandström, Anna Lindhoff-Larsson, Ervin Toth, Gert Lindell, Eduard Jonas, Jacob Freedman, Martin Ljungman, Claes Rudberg, Bo Ohlin, Rebecka Zacharias, Carl-Eric Leijonmarck, Kalev Teder, Anders Ringman, Gunnar Persson, Mehmet Gözen, Olle Eriksson
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?