We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy.
Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope,
expandable
stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new
super-elastic metallic coil stent which has a very strong radial force (EndoCoilTM stent, Instent Co) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal
approach.
It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 months, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical
improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 months, patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging,
and
this new metallic stent seems to have several advantages over the current commerically available ones.
|