Results of the new nitinol self-expandable stents (Instent, Wilson-Cook) for distal biliary strictures

Abstracts

/Netherlands

Journal

of 3.0 (O-6) years; 6 patients (60%) had associated IBD (5 UC, 1 CD). Mean follow-up is 9 (6-12) months. Methods: Single or double 7 and/or 10F plastic stents were inserted through distal (SO%), proximal (10%) and multiple (40%) extrahepatic bile duct strictures. Stent insertion was preceded by papillotomy in 5 cases, dilation with Soehendra catheters in 2 cases, and balloon dilatation in 1 case. The indication for stent insertion was cholangitis 4/12, jaundice 3/12, and progressive cholestasis with pruritus 3/12. Results: Mean duration of stent placement was 10 (7-22) days. All symptoms were relieved in 9/10 patients. The remaining patient had a hilar stricture with recurrence of cholestasis and pruritus at 6 months. He was considered a failure and was subsequently treated with prolonged stent intervention. In all patients comparison of LFT before treatment with values obtained at follow-up revealed a decrease in mean serum bilirubin from 57 (9-226) to 9 (3-14) pmol/l (p < O.Ol), AF from 188 (136-369) to 106 (52-256) U/l (p < O.Ol), GGT from 192 (57-610) to 95 (10-364) U/l (p < 0.02), SGOT from 43 (24-92) to 22 (8-37) U/l (p < O.Ol), and SGPT from 68 (25-155) to 32 (8-59) U/l (p < 0.02). One patient had intervention-related pancreatitis that resolved with conservative treatment. Conclusion: Short-term stent placement is a safe and effective treatment for PSC patients suffering from acute exacerbation of symptoms due to dominant extrahepatic bile duct strictures and overcomes complications of stent occlusion. Results of endoscopic treatment of pancreatic stones. M.E. Smits, E.A.J. Rauws, G.N.J. Tytgat, K. Huibregtse. Department dam,

of Gastroenterology, Netherlands. Aim: To study the

Academic

Medical

Centre,

Amster-

results of endoscopic treatment of pancreatic stones in patients with chronic pancreatitis. Patients and methoak Between 1984 and 1993,53 patients with chronic pancreatitis underwent endoscopic treatment of pancreatic stones. There were 27 males and 26 females with a median age of 48 years (range 15-83). Chronic pancreatitis was due to alcohol abuse (24 pts), bile stones (3 pts), trauma (1 pt), pancreas divisum (1 pt) or idiopathic (24 pts). Indications for stone treatment were pain (30 pts) or recurrent attacks of pancreatitis (23 pts). In all patients, the pancreatogram showed intraductal stones (single 20, multiple 33) with proximal dilation. Additionally a dominant stricture was found in 27 patients. Results: Patients underwent a median of 2 procedures (range l-7) during a median of 1 week (range 1 day-8 months). A sphincterotomy was performed in 41 patients prior to other interventions. Six patients had a nasopancreatic drain for saline flushing, 8 patients had ESWL for stone disintegration and 28 patients had a temporary pancreatic stent. Patients were followed for a median of 33 months (range 4-131). Stone removal was successful in 42 patients (79%) (complete 39, partial 3) and relief of symptoms was seen in 38 of these 42 patients. The remaining 4 underwent pancreatic surgery. Thirteen of the 42 patients (31%) bad recurrent stones after a median of 9.5 months (range 2-108 months), of which 10 were successfully retreated during subse-

of Medicine

47 (1995)

A23

Al -A42

quent ERCP. After completion of stone treatment, 16 of the 42 patients needed pancreatic stenting for strictures. Of these 16 patients, 5 finally underwent pancreatic surgery. Stone removal failed in 11 patients, 4 had pancreatic surgery, 4 were treated with analgesics and 3 had spontaneous relief of symptoms. Early procedure-related complications occurred in 5 patients (9%) and stent dysfunction in 7 patients (13%). Conclusions: Endoscopic treatment of pancreatic stones is a valid approach in patients with pancreatic lithiasis with an acceptable risk profile and efficacy rate. Results of the new Nitinol self-expandable stents (Instent, Wilson-Cook) for distal biliery strictures. M.E. Smits, G.N.J. Tytgat, K. Huibregtse. Department of Gastroenterology, Academic Medical Centre, Amsterdam, Netherlands.

The Nitinol stent is a self-expandable spiral stent made of nickel-titanium alloy. We performed a pilot study to evaluate the method of stent insertion and the efficacy and frequency of stent dysfunction. Patients and methods: Between 1992 and 1994, 28 patients underwent Nitinol stent insertion (Instent 16, Wilson-Cook 12) for distal biliary strictures due to irresectable pancreatic carcinoma (25), papillary carcinoma (1) and cbolangiocarcinoma (2). There were 10 males and 18 females with a median age of 76 years (range 49-92). Nineteen of the 28 patients underwent previous polyethylene (PE) stent insertion. Indications for stent insertion were jaundice (19 pts) and cholangitis (9 pts). Results: Stent insertion failed in 3 patients. Stent deployment was assisted by subsequent balloon dilatation of the stent in 2 patients. Plastic stent insertion was used to brace the Nitinol stent in an other 3 patients. Twenty-five patients were followed for a median of 10 weeks (range l-48) until stent occlusion occurred or until the patients died. Early

25 20 5

results

Relief of jaundice Persistent jaundice (early clogging 3, ingrowth 1, no ERCP 1) Late

results

Died without complications (after 3-48 weeks) Alive, stent in place Elective surgical double bypass Recurrent symptoms (after 6-32 weeks) (clogging 4, ingrowth 2, migration 1, occlusion I)

20 10 1 1 8

Conclusions: Nitinol stents are technically difficult to insert. Stent dysfunction occurred in 13 of 25 patients (52%). There is no major advantage of using Nitinol stents above plastic stents. Cytological

brush&s

M. Drijkoningen merits of Internal Leuven, Belgium.

of ductal lesions at ERCY. E. Macken, I, E. van Aken, W. van Steenbergen. DeparrMedicine

and I Pathology,

U. Z. Gasthuisberg,

The aim of the present study is to report on our experience with the use of endoscopic brushing cytology (EBC) as a