Premature stent clogging is the major problem with plastic stents used in the treatment of malignant biliary strictures. A recent pilot study using a teflon stent without side holes (Tannenbaum stent I suggested improved stent patency compared to conventional polyethylene stents. Aim: A prospective multicenter randomized trial was performed to compare the Tannenbaum teflon stent with the currently available polyethylene endoprosthesis (Cotton-Leung biliary stent set) for the treatment of malignant biliary strictures. Methods: The Tannenbaum stent differs from conventional stents in construction material as well as in stent design. Maintenance of stent-wall integrity by omitting side ports was designed to improve the duration of stent patency. Patients over the age of 18 years with symptomatic malignant biliary strictures located 1cm below the hilum but not involving the ampulla were included in the study. Randomization to a 10-French polyethylene or Tannenbaum stent occurred once a guidewire was negotiated beyond the stricture. Fifty-four patients received Tannenbaum stents (27 males and 27 females). Fifty-two patients received polyethylene stents (35 males and 17 females). The median age was similar in both groups (71 ± 11 years). The presenting total bilirubin was nearly the same in each group (11 ± 8mg/dl vs. 11 ± 9mg/dl). Twenty of 54 patients in the Tannenbaum group, compared to 19 of 52 in the polyethylene group had received previous biliary treatment with a stent and/or sphincterotomy. Results: Polyethylene and Tannenbaum stent placements was successful in 96% and 100% of procedures, respectively. The median time to stent obstruction was 99.8 ± 71.5 days in the polyethylene stent, and 104.4 ± 98.1 days in the Tannenbaum stent. Regardless of stent type, 83% (24/29) of patients with previous treatment of any kind (surgery, stent, or endoscopic sphincterotomy) had a clogged stent at 120 days compared to 66% (47/71) of patients without prior treatment. Conclusions: 1: There was no significant difference in the duration of patency between the polyethylene and Tannenbaum stents. 2: The ease of implantation between the two stents was similar in both groups. 3: There is a trend toward previous biliary treatment negatively affecting subsequent stent patency.
|Original language||English (US)|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging