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Gastroenterology Research and Practice
Volume 2018 (2018), Article ID 3805173, 8 pages
Research Article

Antireflux Metal Stent for Initial Treatment of Malignant Distal Biliary Obstruction

1Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan
2Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
3Department of Hepatology and Pancreatobiliary Internal Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
4Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
5Department of Gastroenterology and Hepatology, Niigata University Hospital, 754 Ichibancho, Asahimachidori, Chuo-ku, Niigata city, Niigata 951-8510, Japan

Correspondence should be addressed to Shinichi Morita

Received 1 October 2017; Accepted 2 January 2018; Published 31 January 2018

Academic Editor: Niccola Funel

Copyright © 2018 Shinichi Morita et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. To compare the use of an antireflux metal stent (ARMS) with that of a conventional covered self-expandable metal stent (c-CSEMS) for initial stenting of malignant distal biliary obstruction (MDBO). Materials and Methods. We retrospectively investigated 59 consecutive patients with unresectable MDBO undergoing initial endoscopic biliary drainage. ARMS was used in 32 patients and c-CSEMS in 27. Technical success, functional success, complications, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), and reintervention were compared between the groups. Results. Stent placement was technically successful in all patients. There were no significant intergroup differences in functional success (ARMS [96.9%] versus c-CSEMS [96.2%]), complications (6.2 versus 7.4%), and RBO (48.4 versus 42.3%). Food impaction was significantly less frequent for ARMS than for c-CSEMS (), but TRBO did not differ significantly between the groups (log-rank test, ). The median TRBO was 180.0 [interquartile range (IQR), 114.0–349.0] days for ARMS and 137.0 [IQR, 87.0–442.0] days for c-CSEMS. In both groups, reintervention for RBO was successfully completed in all patients thus treated. Conclusion. ARMS offers no advantage for initial stent placement, but food impaction is significantly prevented by the antireflux valve.