Mortality in patients undergoing covered self-expandable metal stent revisions in malignant biliary stricture: Does pathology matter?

Anshu Mahajan, Henry Ho, Animesh Jain, Michele E. Rehan, Patrick G. Northup, Melissa S. Phillips, Kristi Ellen, Vanessa M. Shami, Michel Kahaleh

Research output: Contribution to journalArticle

Abstract

Background and Aims: Partially covered metal stents have been extensively used for palliation of obstructive jaundice in malignant distal biliary strictures and can be removed in cases of malfunction or need for tissue diagnosis. We investigated independent predictors of mortality in patients undergoing partially covered metal stents revision (i.e., removal and replacement). Methods: Patients with a distal malignant biliary obstruction palliated with a partially covered metal stent were followed-up prospectively over 5 years until malfunction or death. All patients who required removal of their partially covered metal stents were captured in a specific database. Multivariate analysis was performed on non-surgical patients to assess for independent predictors of death using known risk factors including type of malignancy (adenocarcinoma versus all others), age greater than 55, gender, and exposure to adjuvant chemotherapy and/or radiotherapy. Results: Forty-two patients (28 men, mean age of 62 ± 12 years) underwent partially covered metal stents removal. Of these, biliary drainage was achieved in 38 patients by placement of a new partially covered metal stent (n=32) or plastic stent (n=6). The remaining 4 patients did not undergo stent replacement because of refusal (2), resolution of obstruction (1) and unrelated death (1). Long-term follow-up post removal in patients who were not surgical candidates (n=31) was 35 weeks (95% CI 28-40), with a survival rate of 29% at 10 months. Logistic regression analysis in the 31 patients with unresectable disease showed that a histologic diagnosis of adenocarcinoma was associated with increased mortality post partially covered metal stents revision. Conclusions: Partially covered metal stents revision should be undertaken especially when dealing with a non-adenocarcinoma type cancer.

Original languageEnglish (US)
Pages (from-to)803-806
Number of pages4
JournalDigestive and Liver Disease
Volume42
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Stents
Pathologic Constriction
Pathology
Metals
Mortality
Adenocarcinoma
Self Expandable Metallic Stents
Adjuvant Radiotherapy
Obstructive Jaundice
Adjuvant Chemotherapy
Plastics
Drainage
Neoplasms
Multivariate Analysis
Survival Rate
Logistic Models
Regression Analysis
Databases

Keywords

  • Biliary cancer
  • Covered self-expanding metal stent
  • Pancreatic cancer
  • Self-expanding metal stent

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Mortality in patients undergoing covered self-expandable metal stent revisions in malignant biliary stricture : Does pathology matter? / Mahajan, Anshu; Ho, Henry; Jain, Animesh; Rehan, Michele E.; Northup, Patrick G.; Phillips, Melissa S.; Ellen, Kristi; Shami, Vanessa M.; Kahaleh, Michel.

In: Digestive and Liver Disease, Vol. 42, No. 11, 11.2010, p. 803-806.

Research output: Contribution to journalArticle

Mahajan, A, Ho, H, Jain, A, Rehan, ME, Northup, PG, Phillips, MS, Ellen, K, Shami, VM & Kahaleh, M 2010, 'Mortality in patients undergoing covered self-expandable metal stent revisions in malignant biliary stricture: Does pathology matter?', Digestive and Liver Disease, vol. 42, no. 11, pp. 803-806. https://doi.org/10.1016/j.dld.2010.02.011
Mahajan, Anshu ; Ho, Henry ; Jain, Animesh ; Rehan, Michele E. ; Northup, Patrick G. ; Phillips, Melissa S. ; Ellen, Kristi ; Shami, Vanessa M. ; Kahaleh, Michel. / Mortality in patients undergoing covered self-expandable metal stent revisions in malignant biliary stricture : Does pathology matter?. In: Digestive and Liver Disease. 2010 ; Vol. 42, No. 11. pp. 803-806.
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T1 - Mortality in patients undergoing covered self-expandable metal stent revisions in malignant biliary stricture

T2 - Does pathology matter?

AU - Mahajan, Anshu

AU - Ho, Henry

AU - Jain, Animesh

AU - Rehan, Michele E.

AU - Northup, Patrick G.

AU - Phillips, Melissa S.

AU - Ellen, Kristi

AU - Shami, Vanessa M.

AU - Kahaleh, Michel

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N2 - Background and Aims: Partially covered metal stents have been extensively used for palliation of obstructive jaundice in malignant distal biliary strictures and can be removed in cases of malfunction or need for tissue diagnosis. We investigated independent predictors of mortality in patients undergoing partially covered metal stents revision (i.e., removal and replacement). Methods: Patients with a distal malignant biliary obstruction palliated with a partially covered metal stent were followed-up prospectively over 5 years until malfunction or death. All patients who required removal of their partially covered metal stents were captured in a specific database. Multivariate analysis was performed on non-surgical patients to assess for independent predictors of death using known risk factors including type of malignancy (adenocarcinoma versus all others), age greater than 55, gender, and exposure to adjuvant chemotherapy and/or radiotherapy. Results: Forty-two patients (28 men, mean age of 62 ± 12 years) underwent partially covered metal stents removal. Of these, biliary drainage was achieved in 38 patients by placement of a new partially covered metal stent (n=32) or plastic stent (n=6). The remaining 4 patients did not undergo stent replacement because of refusal (2), resolution of obstruction (1) and unrelated death (1). Long-term follow-up post removal in patients who were not surgical candidates (n=31) was 35 weeks (95% CI 28-40), with a survival rate of 29% at 10 months. Logistic regression analysis in the 31 patients with unresectable disease showed that a histologic diagnosis of adenocarcinoma was associated with increased mortality post partially covered metal stents revision. Conclusions: Partially covered metal stents revision should be undertaken especially when dealing with a non-adenocarcinoma type cancer.

AB - Background and Aims: Partially covered metal stents have been extensively used for palliation of obstructive jaundice in malignant distal biliary strictures and can be removed in cases of malfunction or need for tissue diagnosis. We investigated independent predictors of mortality in patients undergoing partially covered metal stents revision (i.e., removal and replacement). Methods: Patients with a distal malignant biliary obstruction palliated with a partially covered metal stent were followed-up prospectively over 5 years until malfunction or death. All patients who required removal of their partially covered metal stents were captured in a specific database. Multivariate analysis was performed on non-surgical patients to assess for independent predictors of death using known risk factors including type of malignancy (adenocarcinoma versus all others), age greater than 55, gender, and exposure to adjuvant chemotherapy and/or radiotherapy. Results: Forty-two patients (28 men, mean age of 62 ± 12 years) underwent partially covered metal stents removal. Of these, biliary drainage was achieved in 38 patients by placement of a new partially covered metal stent (n=32) or plastic stent (n=6). The remaining 4 patients did not undergo stent replacement because of refusal (2), resolution of obstruction (1) and unrelated death (1). Long-term follow-up post removal in patients who were not surgical candidates (n=31) was 35 weeks (95% CI 28-40), with a survival rate of 29% at 10 months. Logistic regression analysis in the 31 patients with unresectable disease showed that a histologic diagnosis of adenocarcinoma was associated with increased mortality post partially covered metal stents revision. Conclusions: Partially covered metal stents revision should be undertaken especially when dealing with a non-adenocarcinoma type cancer.

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