Diamond Stents for Palliation of Malignant Bile Duct Obstruction: A Prospective Multicenter Evaluation
A. Ferlitsch 1
, C. Oesterreicher 1
, J. M. Dumonceau 2
, J. Deviere 2
, T. Leban 3
, P. Born 3
, T. Rösch 3
, W. Suter 4
, J. Binek 4
, C. Meyenberger 4
, M. Müllner 5
, B. Schneider 6
, R. Schöfl 1
1 Dept. of Internal Medicine IV, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria
2 Dept. of Gastroenterology and Hepatopancreatology, Erasme University Hospital Brussels, Brussels, Belgium
3 Klinikum Rechts der Isar, Department of Internal Medicine II, Technical University of Munich, Munich, Germany
4 Dept. of Gastroenterology, Kantonshospital St Gallen, St Gallen, Switzerland
5 Dept. of Emergency Medicine, University of Vienna, Vienna, Austria
6 Dept. of Medical Statistics, University of Vienna, Vienna, Austria
Background and Study Aims: Various types of self-expandable metal stents have been introduced for biliary drainage in patients with malignant jaundice, showing prolonged patency compared with plastic endoprostheses. However, there has only been prolonged experience with a meaningful number of patients using the Wallstent. We evaluated the Diamond stent, a self-expanding uncoated biliary metal stent, in a prospective uncontrolled multicenter setting.
Patients and Methods: The eligibility criterion was obstructive jaundice due to inoperable malignant disease. Between August 1995 and January 2000, 126 patients, who received a total of 134 Diamond stents in four European centers, were followed prospectively.
Results: Technical and clinical success rates were 96 % and 98 %, respectively. No major procedure-related complications occurred. The 30-day mortality rate was 13 %. Stent occlusion occurred in 28 patients (22 %). Overall median stent patency was 477 days; overall median survival was 173 days. Stent occlusion, confirmed by endoscopic retrograde cholangiopancreatography, was successfully treated with plastic stents in all patients. Cost analysis revealed estimated costs of €3440 per patient for palliative treatment with the Diamond stent.
Conclusions: The Diamond stent compares favorably with other biliary metal stents for patients requiring biliary drainage of malignant jaundice.
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