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- Kullman, Eric, et al.
(författare)
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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- 2010
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Ingår i: GASTROINTESTINAL ENDOSCOPY. - : Elsevier Science B. V., Amsterdam. - 0016-5107 .- 1097-6779. ; 72:5, s. 915-923
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Tidskriftsartikel (refereegranskat)abstract
- Background: Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients. Objective: To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction. Design: Randomized, multicenter trial conducted between January 2006 and October 2008. Setting: Ten sites serving a total catchment area of approximately 2.8 million inhabitants. Patients: A total of 400 patients with unresectable distal malignant biliary obstruction. Interventions: ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction. Main Outcome Measurements: Time to stent failure, survival time, and complication rate. Results: The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030). Limitations: Randomization was not blinded. Conclusions: There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.
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| 2. |
- Sadic, Jalal, et al.
(författare)
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Bleeding peptic ulcer - time trends in incidence, treatment and mortality in Sweden.
- 2009
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Ingår i: Alimentary pharmacology & therapeutics. - : Wiley. - 1365-2036 .- 0269-2813. ; 30, s. 392-398
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: The incidence of peptic ulcer disease was expected to decrease following the introduction of acid inhibitors and H. pylori eradication. Aim: This study analyses possible changes in the incidence of bleeding peptic ulcer, treatment and mortality over time. Methods: Residents of Malmö hospitalised for bleeding gastric or duodenal ulcer disease1987-2004 were identified in hospital databases (n=1610). The material was divided in 6-year periods in order to identify changes over time. All patients who had been submitted to emergency surgery (n=137) were reviewed. Results: The incidence rate for bleeding gastric or duodenal ulcers decreased by one half in males and by one third in females and emergency operations decreased significantly (9.2, 7.5 and 5.7% during the three time periods respectively (p<0.05). The postoperative mortality tended to decrease (9.7, 2.4 and 3.7% respectively) and the 30-day mortality rates in the whole material were 1.2, 3.6 and 3.4% during the different time periods. Conclusion: The incidence of bleeding gastric and duodenal ulcer disease has decreased markedly. Operative treatment has been replaced by endoscopic treatment. The bleeding ulcer related mortality was less than 4% and has not changed over time.
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