Dataset Information

Early malfunction of a biliary self-expandable metal stent with an antireflux valve: A case report.

ABSTRACT:

Rationale

Biliary drainage is essential to resolve jaundice in patients with malignant biliary obstruction. Recently, a biliary self-expandable metal stent (SEMS) with an antireflux valve was developed to prevent enteric-biliary reflux. Its antireflux valve was made of expanded polytetrafluoroethylene (ePTFE), a biostable and biocompatible material. Changes of the ePTFE membrane of medical devices are rarely reported in clinical practice.

Patient concerns

A 59-year-old woman was admitted with a complaint of jaundice. Around 1 month before, she underwent endoscopic biliary stenting using a SEMS with an antireflux valve.

Diagnosis

Acute cholangitis due to stent clogging was detected on abdominal computed tomography.

Interventions

Endoscopic retrograde cholangiopancreatography and removal of the SEMS with deformity were performed.

Outcomes

The obstructive jaundice was rapidly resolved after the removal of the clogged stent.

Lessons

Although the ePTFE membrane is widely used to make medical devices, unexpected changes could occur after the membrane is exposed to bile juice in the duodenum. When performing biliary stenting using a SEMS with an antireflux valve, both the risk of early malfunction and the benefit of the antireflux effect should be considered.

SUBMITTER: Kim SH

PROVIDER: S-EPMC7220473 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Early malfunction of a biliary self-expandable metal stent with an antireflux valve: A case report.

Kim Sang Hoon SH Oh Chi Hyuk CH Lee Jae Min JM Choi Seong Ji SJ Choi Hyuk Soon HS Kim Eun Sun ES Keum Bora B Jeen Yoon Tae YT Chun Hoon Jai HJ Lee Hong Sik HS Kim Chang Duck CD

Medicine 20200401 16

<h4>Rationale</h4>Biliary drainage is essential to resolve jaundice in patients with malignant biliary obstruction. Recently, a biliary self-expandable metal stent (SEMS) with an antireflux valve was developed to prevent enteric-biliary reflux. Its antireflux valve was made of expanded polytetrafluoroethylene (ePTFE), a biostable and biocompatible material. Changes of the ePTFE membrane of medical devices are rarely reported in clinical practice.<h4>Patient concerns</h4>A 59-year-old woman was a ...[more]

PMID: 32311973

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Project description:BackgroundSelf-expanding metallic stent (SEMS) is a palliative therapy for patients with malignant central airway obstruction (CAO) or tracheoesophageal fistula (TEF). Despite this, many patients experience death shortly after SEMS placement.AimsWe aimed to investigate the effect of SEMS on the palliative treatment between malignant CAO and malignant TEF patients and investigate the associated prognostic factors of the 3-month survival.MethodsWe performed a single-center, retrospective study of malignant CAO or TEF patients receiving SEMS placement. Clinical data were collected using the standardized data abstraction forms. Data were analyzed using SPSS 22.0. A two-sided P-value <0.05 was statistically significant.Results106 malignant patients (82 CAO and 24 TEF) receiving SEMS placement were included. The body mass index (BMI), hemoglobin levels, and albumin levels in the malignant TEF group were lower than in the malignant CAO group (all P < 0.05). The procalcitonin levels, C-reactive protein levels, and the proportion of inflammatory lesions were higher in the malignant TEF group than in the malignant CAO group (all P < 0.05). The proportion of symptomatic improvement after the SEMS placement was 97.6% in the malignant CAO group, whereas 50.0% in the malignant TEF group, with a significant difference (P = 0.000). Three months after SEMS placement, the survival rate at was 67.0%, significantly lower in the malignant TEF group than in the malignant CAO group (45.8% vs. 73.2%, P = 0.013). Multivariate analysis revealed that BMI [odds ratio (OR) = 1.841, 95% certificated interval (CI) (1.155-2.935), P = 0.010] and neutrophil percentage [OR = 0.936, 95% CI (0.883-0.993), P = 0.027] were the independent risk factors for patients who survived three months after SEMS placement.ConclusionsWe observed symptom improvement in malignant CAO and TEF patients after SEMS placement. The survival rate in malignant TEF patients after SEMS placement was low, probably due to aspiration pneumonitis and malnutrition. Therefore, we recommend more aggressive treatment modalities in patients with malignant TEF, such as strong antibiotics, nutrition support, and strategic ventilation. More studies are needed to investigate the prognostic factors in patients with malignant airway disorders receiving SEMS placement.

Dataset Information

Early malfunction of a biliary self-expandable metal stent with an antireflux valve: A case report.

Rationale

Patient concerns

Diagnosis

Interventions

Outcomes

Lessons

Publications

Early malfunction of a biliary self-expandable metal stent with an antireflux valve: A case report.

Similar Datasets

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