Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness |
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Authors: | P Katsinelos D Paikos J Kountouras G Chatzimavroudis G Paroutoglou I Moschos A Gatopoulou A Beltsis C Zavos B Papaziogas |
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Institution: | (1) Department of Endoscopy and Motility Unit, Central Hospital, 41 Ethnikis Aminis St., Thessaloniki, 546 35, Greece;(2) Department of Gastroenterology, “Theagenio” Anticancer Hospital, 2 Al. Symeonidi St., Thessaloniki, 540 07, Greece;(3) Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, 49 Konstantinoupoleos St., Thessaloniki, 546 42, Greece |
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Abstract: | Background Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better
patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum)
stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness
between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile
duct obstruction.
Methods In this study, 47 patients (median age, 73 years, range, 56–86 years) with inoperable malignant distal common bile duct strictures
were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery
for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups.
Cost-effectiveness analysis also was performed for the two study groups.
Results The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal
group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum
stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001).
Conclusions Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum
stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases
and expected short survival time. |
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Keywords: | Malignant distal bile duct obstruction Metal stent Stent clogging Tannenbaum stent Endoscopic drainage Patency Cost effectiveness ERCP |
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