Expandable metal biliary stents are currently used to treat biliary tract obstruction. Malignant biliary obstruction can be caused by direct tumor infiltration, extrinsic compression, adjacent inflammation, desmoplastic reaction from tumors or, more commonly, a combination of more than one of the aforementioned factors. Pancreatic cancer is the most common cause of malignant biliary obstruction and jaundice is the most common symptom in the course of the disease.
Since June 2012, we at Hospital da Luz began using in the new Cook Evolution Biliary uncovered stent in our department. In the first eight months, we used this new device in 30 patients: 17 with pancreatic cancer, eight with cholangiocarcinoma, two with gall bladder carcinoma, and two with hepatic metastasis from colon cancer.
All patients were presented to us with obstructive jaundice. Our preliminary results with the new stent were excellent. All stents were successfully inserted endoscopically with immediate biliary drainage.
In our preliminary evaluation, we consider the Evolution Biliary uncovered stent very friendly to use, thanks to the new, controlled release delivery system. The accuracy in delivering the stent is very high with less degree of foreshortening. We also managed to reduce the radiation exposure, using only the endoscopy view in stent delivery.
The following are a few of our Evolution Biliary uncovered stent cases.
Case 1
An 87-year-old patient admitted with obstructive jaundice associated with inoperable pancreatic cancer. A malignant stricture (about 3 cm in length) was located in the distal part of the common bile duct (CBD). After sphincterotomy, a 60 mm Cook Evolution Biliary uncovered stent was deployed over the guide wire with immediate drainage of black bile.
Case 2
A 63-year-old patient was admitted with obstructive jaundice. CT and MRI showed pancreatic head mass with hepatic metastasis. In cholangiogram we observed 2 stenoses in CBD (hilar and distal segment). We used the 80 mm Evolution Biliary uncovered stent with resolution of both stenoses.
Case 3
An 80-year-old patient was admitted with previous diagnoses of pancreatic cancer. In June 2012, ERCP with ST the first 60 mm Evolution Biliary uncovered stent was placed. Approximately 5 months later, the patient was admitted with jaundice and tumor ingrowth into the stent lumen. During a second ERCP, a second Evolution Biliary uncovered stent (80 mm) was placed.
Images courtesy of David Serra, MD, Hospital da Luz, Lisbon, Portugal.
Previously published in The Channel.
Interventional Radiology access now for ERCP
The same performance that sets the standard for wire guide access in interventional radiology is now available for ERCP. We tailored interventional radiology technology specifically for ERCP wire guide access. With one of the most flexible tips on the market, Acrobat gives you the same Cook-pioneered technology that interventionalists rely on everyday for difficult selective and superselective vascular access.
Performance you can measure
The only sure way to prove wire guide tip flexibility is to measure it. That’s what we did, and Acrobat performed superbly. It is so flexible that it required the least amount of gram-force to initiate an alpha loop 1 cm from the distal tip. So now, whether you’re cannulating or traversing difficult strictures, the Acrobat Calibrated Tip wire guide can be your everyday wire guide that performs like a specialty wire.
Tip flexibility: Changing with the times
One of your procedural goals will never change: simple, reliable access during ERCP. One thing that has changed is tip flexibility. Over time, wire guides have become more and more flexible. At Cook, we didn’t stop until we made a wire guide tip that is measurably one of the most flexible on the market: the Acrobat Calibrated Tip wire guide.
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Acrobat™ Calibrated Tip Wire Guide
Whether treating strictures in the biliary tract, duodenum, colon or esophagus, the Evolution family of stents gives you the unique ability to deploy, recapture and/or reposition the stent.
Unlike with other systems, Evolution stents do not jump during deployment, giving you smoother, more predictable delivery. That kind of precision and control makes it easier to accurately place stents the very first time, potentially reducing repeat procedures.
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Evolution Biliary
Evolution Duodenal
Evolution Colonic
Evolution Esophageal
EVOLUTION® BILIARY
Evolutionary Design, Control and Precision
In palliating the biliary tract you need a stent that you can place accurately, that maintains patency and that minimizes migration. The Evolution Biliary stent gives you all three.
- Dedicated platinum core wire that delivers excellent full-length radiopacity
- Potentially reduce tumor ingrowth with the small-cell size configuration
- Most favorable radial and axial forces means the stent maintains its flexibility and ductal conformance while sustaining a patent biliary tract
- Maximized pushability and minimized stretching, as a result of Cook’s patent pending Flexor® Plus technology, means you can get your stent to the exact position you require
Go here to learn more about the Evolution Biliary Uncovered Controlled-Release Stent
EVOLUTION® DUODENAL
Evolutionary Design
In duodenal stenting procedures, exact stent placement is vital for positive patient outcomes. The Evolution Duodenal gives you unparalleled control and maneuverability to achieve that goal. Now you can smoothly deliver a stent that stays in place by fully conforming to the natural curves of the anatomy, potentially reducing the risk of migration and/or other delayed complications.
- 18 crowns for enhanced, evenly distributed radial force
- Proximal and distal flanges reduce migration
- 4 radiopaque markers to identify the proximal and distal ends of the stent to aid in accurate placement
- Flexor® technology delivers excellent catheter flexibility and stability without kinking
Go here to learn more about the Evolution Duodenal Uncovered Controlled-Release Stent
EVOLUTION® COLONIC
Evolutionary Design
Whether you’re confronting malignant strictures, gastric outlet obstruction or creating a bridge to surgery, the Evolution Colonic Stent delivers the unparalleled control and maneuverability you need to confidently deliver a stent that fully conforms to the natural curves of the anatomy while potentially reducing post-placement risks. 20 crowns for enhanced, evenly distributed radial force Proximal and distal flanges reduce migration 4 radiopaque markers to identify the proximal and distal ends of the stent to aid in accurate placement Flexor® technology delivers excellent catheter flexibility and stability without kinking
- 20 crowns for enhanced, evenly distributed radial force
- Proximal and distal flanges reduce migration
- 4 radiopaque markers to identify the proximal and distal ends of the stent to aid in accurate placement
- Flexor® technology delivers excellent catheter flexibility and stability without kinking
Go here to learn more about the Evolution Colonic Uncovered Controlled-Release Stent
EVOLUTION® ESOPHAGEAL
Evolutionary Design
To give you the widest range of treatment options, Evolution Esophageal stents come partially or fully covered. And they all deploy smoothly and confidently thanks to the stress-reducing, controlled release delivery system.
Partially Covered Design
- Encased inside and out with silicone to prevent ingrowth and decrease food bolus impaction
- Uncovered proximal and distal flanges anchor stent to lessen the risk of migration
- “Lasso” loop on proximal end gives you option to reposition the stent immediately after placement
Fully Covered Design
- Silicone coating extending throughout the length of each stent designed to enhance treatment of malignant esophageal TE fistulas
- Dual lasso loops for proximal and distal stent repositioning immediately after placement
Go here to learn more about the Evolution Esophageal Controlled-Release Stent