Abstract:
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Purpose: The Biliary WALLSTENT(Boston Scientific, Watertown, MA) is the most studied metallic biliary endoprosthesis in the palliation of malignant obstructive jaundice. The newer Bard LUMINEXX (Angiomed, Karlsruhe, Germany) stent system offers several theoretical advantages. We present the outcome of a cohort of LUMINEXX stents in comparison to the WALLSTENT.
Methods and Materials: The WALLSTENT is a self-expanding prosthesis constructed of braided cobalt based monofilament that is inserted via 7F delivery system. The stent shortens distally as it expands. The Bard LUMINEXX stent is a self-expanding prosthesis constructed of contigious nitinol tube which is laser cut to allow flexibility and expansion. The stent is inserted via 6F delivery system and does not shorten. Between May 2001 and December 2002, 55 WALLSTENTS were inserted in 46 patients [24 males, mean age 68 years, range 43-94 years]. During the same period 29 LUMINEXX stents were placed in 25 patients [15 males, mean age 69 years, range 44-89 years]. Obstruction was due to pancreatic cancer in 25 and 16, metastasis in 12 and 5, cholangiocarcinoma in 6 and 2 and others in 3 and 2 cases respectively in the two groups. The position of the stricture was distal CBD in 28 and 13, mid CBD in 11 and 9 and hilar in 7 and 2 respectively. Both groups were matched in terms of presence of metastatic disease [21 versus 14], pre-procedure serum Creatinine [1.15 mg/dl vs 1.06 mg/dl] and serum albumin [25 gms/dl for both groups]. The pre-procedure serum bilirubin was significantly higher [14.4 mg/dl] in the WALLSTENT group compared to LUMINEXX group [13.2mg/dl].
Results: Technically successful stent insertion was achieved in all cases. 3 day post bilirubin dropped to 10.1 mg/dl in the WALLSTENT group and to 8.6 mg/dl in the LUMINEXX group [not significant]. Mean patient survival was 157 days [range 5 -656 days] in the WALLSTENT group and 132 days [range 13-310 days] in the LUMINEXX group. 4/46 WALLSTENTS occluded on follow up after a mean period of 98 days of which 3 were due to tumor ingrowth. 8/26 LUMINEXX stents blocked [ p<0.01] after a mean period of 97 days of which 6 were due to tumor ingrowth and 2 due to biliary sludge. Complications were comparable 2 subphrenic abscesses and 1 duodenal erosion in the WALLSTENT group and 2 subphrenic abscesses and 2 cholangitis in the LUMINEXX group.
Conclusion: Early experience suggests that in spite of theoretical advantages the outcome of LUMINEXX stent is comparable to the Biliary WALLSTENT in most aspects apart from primary stent patency where its performance is significantly worse.
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Roy-Choudhury MD, S,
Comparison between the 7F Wallstent System and the Newer 6F Luminexx Stent System in Palliation of Malignant Obstructive Jaundice. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3102535.html
