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Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study
Background The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and...
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| Published in: | Gastrointestinal endoscopy 2003-02, Vol.57 (2), p.178-182 |
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| container_title | Gastrointestinal endoscopy |
| container_volume | 57 |
| creator | Kaassis, Mehdi Boyer, Jean Dumas, Rémi Ponchon, Thierry Coumaros, Dimitri Delcenserie, Richard Canard, Jean-Marc Fritsch, Jacques Rey, Jean-François Burtin, Pascal |
| description | Background The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and to define factors that predict survival of these patients.
Methods: One hundred eighteen patients (mean age 75 years) with malignant strictures of the common bile duct were randomized to placement of a plastic stent or metal stent. Comparisons were made with the Mann-Whitney or chi-square test as indicated; survival rates were compared with a Cox proportional hazards model.
Results: There was no significant difference in survival between the two groups. Time to first obstruction was longer for patients in the metal stent group (metal stent, median not reached vs. plastic stent, 5 months;
p=0.007). The number of additional days of hospitalization, days of antibiotic therapy, and the numbers of ERCPs and transabdominal US procedures was significantly higher in the plastic stent group. After multivariate analysis, only the presence of liver metastases was independently related to survival (
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| doi_str_mv | 10.1067/mge.2003.66 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_72997487</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0016510703800639</els_id><sourcerecordid>72997487</sourcerecordid><originalsourceid>FETCH-LOGICAL-c427t-3cfddbe150aa3f78cb1387241f340446dea3b7333b03cb112b26006decbf20e3</originalsourceid><addsrcrecordid>eNptkM9LHDEYhkOp1K3tybvkUi9l1i_JTDJ7KiL9BYIi3kMm-aKRzMw2yQj615tlF7z0FHjzfC8vDyGnDNYMpLoYH3DNAcRayg9kxWCjGqnU5iNZATDZdAzUMfmc8xMA9FywT-SY8a6TqocVSbfR5BIsnRMdsZhIc8GpZOp3gYnhYTJTqWEKtiwJ6expeURq53GcJzqEiNQttvygd5iXWA8rYGgyk5vH8IqObtOct2hLeMZas7iXL-TIm5jx6-E9Ife_ft5f_Wmub37_vbq8bmzLVWmE9c4NyDowRnjV24GJXvGWedFC20qHRgxKCDGAqH-MD1wC1NgOngOKE3K-r60D_i2Yix5DthijmXBeslZ8s1Ftryr4fQ_aujQn9HqbwmjSi2agd4Z1Nax3hrWUlT471C7DiO6dPSitwLcDYLI10VcVNuR3ru246FlbuW7PYXXwHDDpbANOFl1IVZd2c_jvgDemAJfb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>72997487</pqid></control><display><type>article</type><title>Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study</title><source>ScienceDirect Journals</source><creator>Kaassis, Mehdi ; Boyer, Jean ; Dumas, Rémi ; Ponchon, Thierry ; Coumaros, Dimitri ; Delcenserie, Richard ; Canard, Jean-Marc ; Fritsch, Jacques ; Rey, Jean-François ; Burtin, Pascal</creator><creatorcontrib>Kaassis, Mehdi ; Boyer, Jean ; Dumas, Rémi ; Ponchon, Thierry ; Coumaros, Dimitri ; Delcenserie, Richard ; Canard, Jean-Marc ; Fritsch, Jacques ; Rey, Jean-François ; Burtin, Pascal</creatorcontrib><description>Background The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and to define factors that predict survival of these patients.
Methods: One hundred eighteen patients (mean age 75 years) with malignant strictures of the common bile duct were randomized to placement of a plastic stent or metal stent. Comparisons were made with the Mann-Whitney or chi-square test as indicated; survival rates were compared with a Cox proportional hazards model.
Results: There was no significant difference in survival between the two groups. Time to first obstruction was longer for patients in the metal stent group (metal stent, median not reached vs. plastic stent, 5 months;
p=0.007). The number of additional days of hospitalization, days of antibiotic therapy, and the numbers of ERCPs and transabdominal US procedures was significantly higher in the plastic stent group. After multivariate analysis, only the presence of liver metastases was independently related to survival (
p<0.0005; OR=2.25). This variable defined a group with a shorter survival. Median survival of patients with hepatic metastasis at diagnosis was 2.7 months compared with 5.3 months for patients without liver metastasis; in the latter group, the overall cost associated with metal stents was lower than for plastic stents.
Conclusions: Metal stent placement is the most effective treatment of inoperable malignant common bile duct stricture. Placement of a metal stent is cost effective in patients without hepatic metastases, whereas a plastic stent should be placed in patients with spread of the tumor to the liver.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1067/mge.2003.66</identifier><identifier>PMID: 12556780</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Chi-Square Distribution ; Cholestasis, Intrahepatic - mortality ; Cholestasis, Intrahepatic - pathology ; Cholestasis, Intrahepatic - therapy ; Common Bile Duct Neoplasms - mortality ; Common Bile Duct Neoplasms - pathology ; Common Bile Duct Neoplasms - therapy ; Diseases of the digestive system ; Female ; Humans ; Male ; Medical sciences ; Metals - therapeutic use ; Middle Aged ; Neoplasm Staging ; Palliative Care - methods ; Plastics - therapeutic use ; Predictive Value of Tests ; Probability ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk Assessment ; Statistics, Nonparametric ; Stents ; Survival Analysis ; Treatment Outcome</subject><ispartof>Gastrointestinal endoscopy, 2003-02, Vol.57 (2), p.178-182</ispartof><rights>2003 2003 American Society for Gastrointestinal Endoscopy</rights><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-3cfddbe150aa3f78cb1387241f340446dea3b7333b03cb112b26006decbf20e3</citedby><cites>FETCH-LOGICAL-c427t-3cfddbe150aa3f78cb1387241f340446dea3b7333b03cb112b26006decbf20e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14523814$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12556780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kaassis, Mehdi</creatorcontrib><creatorcontrib>Boyer, Jean</creatorcontrib><creatorcontrib>Dumas, Rémi</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Coumaros, Dimitri</creatorcontrib><creatorcontrib>Delcenserie, Richard</creatorcontrib><creatorcontrib>Canard, Jean-Marc</creatorcontrib><creatorcontrib>Fritsch, Jacques</creatorcontrib><creatorcontrib>Rey, Jean-François</creatorcontrib><creatorcontrib>Burtin, Pascal</creatorcontrib><title>Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and to define factors that predict survival of these patients.
Methods: One hundred eighteen patients (mean age 75 years) with malignant strictures of the common bile duct were randomized to placement of a plastic stent or metal stent. Comparisons were made with the Mann-Whitney or chi-square test as indicated; survival rates were compared with a Cox proportional hazards model.
Results: There was no significant difference in survival between the two groups. Time to first obstruction was longer for patients in the metal stent group (metal stent, median not reached vs. plastic stent, 5 months;
p=0.007). The number of additional days of hospitalization, days of antibiotic therapy, and the numbers of ERCPs and transabdominal US procedures was significantly higher in the plastic stent group. After multivariate analysis, only the presence of liver metastases was independently related to survival (
p<0.0005; OR=2.25). This variable defined a group with a shorter survival. Median survival of patients with hepatic metastasis at diagnosis was 2.7 months compared with 5.3 months for patients without liver metastasis; in the latter group, the overall cost associated with metal stents was lower than for plastic stents.
Conclusions: Metal stent placement is the most effective treatment of inoperable malignant common bile duct stricture. Placement of a metal stent is cost effective in patients without hepatic metastases, whereas a plastic stent should be placed in patients with spread of the tumor to the liver.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Cholestasis, Intrahepatic - mortality</subject><subject>Cholestasis, Intrahepatic - pathology</subject><subject>Cholestasis, Intrahepatic - therapy</subject><subject>Common Bile Duct Neoplasms - mortality</subject><subject>Common Bile Duct Neoplasms - pathology</subject><subject>Common Bile Duct Neoplasms - therapy</subject><subject>Diseases of the digestive system</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metals - therapeutic use</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Palliative Care - methods</subject><subject>Plastics - therapeutic use</subject><subject>Predictive Value of Tests</subject><subject>Probability</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Stents</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNptkM9LHDEYhkOp1K3tybvkUi9l1i_JTDJ7KiL9BYIi3kMm-aKRzMw2yQj615tlF7z0FHjzfC8vDyGnDNYMpLoYH3DNAcRayg9kxWCjGqnU5iNZATDZdAzUMfmc8xMA9FywT-SY8a6TqocVSbfR5BIsnRMdsZhIc8GpZOp3gYnhYTJTqWEKtiwJ6expeURq53GcJzqEiNQttvygd5iXWA8rYGgyk5vH8IqObtOct2hLeMZas7iXL-TIm5jx6-E9Ife_ft5f_Wmub37_vbq8bmzLVWmE9c4NyDowRnjV24GJXvGWedFC20qHRgxKCDGAqH-MD1wC1NgOngOKE3K-r60D_i2Yix5DthijmXBeslZ8s1Ftryr4fQ_aujQn9HqbwmjSi2agd4Z1Nax3hrWUlT471C7DiO6dPSitwLcDYLI10VcVNuR3ru246FlbuW7PYXXwHDDpbANOFl1IVZd2c_jvgDemAJfb</recordid><startdate>20030201</startdate><enddate>20030201</enddate><creator>Kaassis, Mehdi</creator><creator>Boyer, Jean</creator><creator>Dumas, Rémi</creator><creator>Ponchon, Thierry</creator><creator>Coumaros, Dimitri</creator><creator>Delcenserie, Richard</creator><creator>Canard, Jean-Marc</creator><creator>Fritsch, Jacques</creator><creator>Rey, Jean-François</creator><creator>Burtin, Pascal</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030201</creationdate><title>Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study</title><author>Kaassis, Mehdi ; Boyer, Jean ; Dumas, Rémi ; Ponchon, Thierry ; Coumaros, Dimitri ; Delcenserie, Richard ; Canard, Jean-Marc ; Fritsch, Jacques ; Rey, Jean-François ; Burtin, Pascal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-3cfddbe150aa3f78cb1387241f340446dea3b7333b03cb112b26006decbf20e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Cholestasis, Intrahepatic - mortality</topic><topic>Cholestasis, Intrahepatic - pathology</topic><topic>Cholestasis, Intrahepatic - therapy</topic><topic>Common Bile Duct Neoplasms - mortality</topic><topic>Common Bile Duct Neoplasms - pathology</topic><topic>Common Bile Duct Neoplasms - therapy</topic><topic>Diseases of the digestive system</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metals - therapeutic use</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Palliative Care - methods</topic><topic>Plastics - therapeutic use</topic><topic>Predictive Value of Tests</topic><topic>Probability</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Stents</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kaassis, Mehdi</creatorcontrib><creatorcontrib>Boyer, Jean</creatorcontrib><creatorcontrib>Dumas, Rémi</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Coumaros, Dimitri</creatorcontrib><creatorcontrib>Delcenserie, Richard</creatorcontrib><creatorcontrib>Canard, Jean-Marc</creatorcontrib><creatorcontrib>Fritsch, Jacques</creatorcontrib><creatorcontrib>Rey, Jean-François</creatorcontrib><creatorcontrib>Burtin, Pascal</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kaassis, Mehdi</au><au>Boyer, Jean</au><au>Dumas, Rémi</au><au>Ponchon, Thierry</au><au>Coumaros, Dimitri</au><au>Delcenserie, Richard</au><au>Canard, Jean-Marc</au><au>Fritsch, Jacques</au><au>Rey, Jean-François</au><au>Burtin, Pascal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2003-02-01</date><risdate>2003</risdate><volume>57</volume><issue>2</issue><spage>178</spage><epage>182</epage><pages>178-182</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>Background The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and to define factors that predict survival of these patients.
Methods: One hundred eighteen patients (mean age 75 years) with malignant strictures of the common bile duct were randomized to placement of a plastic stent or metal stent. Comparisons were made with the Mann-Whitney or chi-square test as indicated; survival rates were compared with a Cox proportional hazards model.
Results: There was no significant difference in survival between the two groups. Time to first obstruction was longer for patients in the metal stent group (metal stent, median not reached vs. plastic stent, 5 months;
p=0.007). The number of additional days of hospitalization, days of antibiotic therapy, and the numbers of ERCPs and transabdominal US procedures was significantly higher in the plastic stent group. After multivariate analysis, only the presence of liver metastases was independently related to survival (
p<0.0005; OR=2.25). This variable defined a group with a shorter survival. Median survival of patients with hepatic metastasis at diagnosis was 2.7 months compared with 5.3 months for patients without liver metastasis; in the latter group, the overall cost associated with metal stents was lower than for plastic stents.
Conclusions: Metal stent placement is the most effective treatment of inoperable malignant common bile duct stricture. Placement of a metal stent is cost effective in patients without hepatic metastases, whereas a plastic stent should be placed in patients with spread of the tumor to the liver.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>12556780</pmid><doi>10.1067/mge.2003.66</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Biological and medical sciences Chi-Square Distribution Cholestasis, Intrahepatic - mortality Cholestasis, Intrahepatic - pathology Cholestasis, Intrahepatic - therapy Common Bile Duct Neoplasms - mortality Common Bile Duct Neoplasms - pathology Common Bile Duct Neoplasms - therapy Diseases of the digestive system Female Humans Male Medical sciences Metals - therapeutic use Middle Aged Neoplasm Staging Palliative Care - methods Plastics - therapeutic use Predictive Value of Tests Probability Prognosis Proportional Hazards Models Prospective Studies Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Risk Assessment Statistics, Nonparametric Stents Survival Analysis Treatment Outcome |
| title | Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study |
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