Long-anchoring Stent Method as a Rescue Technique for Early Dysfunction of Covered Self-Expandable Metal Stents in Distal Malignant Biliary Obstruction: A Retrospective Case Series.
The long-anchoring stent method appears to be a safe and effective approach for managing early dysfunction of covered SEMS in patients with distal malignant biliary obstruction.
Where it sits
this study against the rest of the igf-1 lr3 (long r3 igf-1) corpusSummary and findings
This study evaluated the long-anchoring stent method for patients with distal malignant biliary obstruction who experienced early recurrent biliary obstruction after self-expandable metal stent placement. The method was applied to 15 patients, with outcomes measured after reintervention. Clinical success was reported in all patients, with significant changes in SEMS angulation.
Abstract
<h4>Objective</h4>Covered self-expandable metal stents (SEMS) are widely used for treating distal malignant biliary obstruction (MBO). Severe SEMS angulation can cause stent dysfunction. Placement of a long double-pigtail plastic stent inside the SEMS (the "long-anchoring stent method") may straighten the angulated SEMS, thereby achieving effective biliary drainage. This study aimed to report the clinical outcomes of this novel method.<h4>Methods</h4>We retrospectively analyzed 15 patients with distal MBO who underwent initial SEMS placement, subsequently experienced clinical failure or early recurrent biliary obstruction (RBO) within 90 days of initial placement, and underwent reintervention with the long-anchoring stent method between April 2020 and March 2025.<h4>Results</h4>The median follow-up period was 307 days after the anchoring procedure. For the primary outcome, clinical success was achieved in all 5 patients with initial SEMS clinical failure and in all 15 patients overall. The median angle of the SEMS significantly straightened from 128.3° with the initial SEMS alone to 151.5° after anchoring stent placement (<i>p</i> < 0.001). As an exploratory analysis of the 10 patients with early RBO, the median time to RBO increased from 21 days after initial SEMS placement to 148 days after anchoring procedure. No severe procedure-related adverse events occurred.<h4>Conclusion</h4>The long-anchoring stent method is a simple, safe, and viable strategy for rescuing early dysfunction of covered SEMS, possibly in part through straightening of the SEMS angulation.<h4>Trial registration</h4>N/A.
Background
This paper addresses the issue of severe angulation in covered self-expandable metal stents (SEMS) used for distal malignant biliary obstruction (MBO), which can lead to stent dysfunction. Prior knowledge indicates that SEMS are commonly used for biliary drainage, but their effectiveness can be compromised by angulation. The study is significant as it proposes a novel technique, the long-anchoring stent method, to potentially enhance the performance of SEMS in patients experiencing early dysfunction.
Methods
The study utilized a retrospective design, analyzing 15 patients who underwent initial SEMS placement and subsequently experienced clinical failure or early recurrent biliary obstruction within 90 days. These patients underwent reintervention with the long-anchoring stent method between April 2020 and March 2025. The primary outcome was clinical success, while secondary outcomes included changes in SEMS angle and time to recurrent biliary obstruction.
Results
The primary outcome showed clinical success in all 15 patients. The median angle of the SEMS significantly increased from 128.3° to 151.5° after the anchoring procedure, with a p-value of < 0.001. For the exploratory analysis of 10 patients with early recurrent biliary obstruction, the median time to RBO improved from 21 days after initial SEMS placement to 148 days after the anchoring procedure.
Interpretation
The findings suggest that the long-anchoring stent method may effectively address early dysfunction of SEMS by straightening the stent angulation. While the results are statistically significant, the clinical relevance remains uncertain due to the small sample size and retrospective nature of the study. These limitations may confound the conclusions and suggest the need for larger, prospective studies to validate the findings.
Key findings
- Clinical success achieved in all 15 patients overall.
- Median angle of the SEMS significantly straightened from 128.3° to 151.5° after anchoring stent placement, p < 0.001.
- Median time to recurrent biliary obstruction increased from 21 days to 148 days after the anchoring procedure.
Limitations
- small sample size of 15 patients
- retrospective design limits generalizability
- no control group for comparison
- short follow-up period for assessing long-term outcomes