• Kyong Joo Lee, Moon Jae Chung, Jeong Youp Park, Don Haeng Lee, Suk Jung, Byoung Wook Bang, Seung Woo Park, Jae Bock Chung, Si Young Song, and Seungmin Bang.
• Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
• Dig Endosc. 2013 May 1;25(3):308-12.

Background And AimTranspapillary stent insertion is the standard treatment for palliating malignant biliary obstruction. However, luminal occlusion often occurs due to sludge formation, tumor ingrowth, or tumor overgrowth. Currently, influx of duodenal contents by duodenobiliary reflux is considered a mechanism of stent obstruction. The aim of the present study was to evaluate the efficacy and safety of a metal stent with an anti-reflux valve in distal malignant biliary obstruction.MethodsThirty-two patients diagnosed with unresectable malignant biliary obstruction were enrolled. This trial was conducted at two tertiary hospitals in Korea from June 2009 to June 2011. An uncovered metal stent (M.I.Tech) with an S-type anti-reflux valve was placed.ResultsA total of 32 patients were enrolled. The technical success rate of stent insertion was 100%. The median duration of stent patency was 14.4 months. Stent occlusion occurred in 11 cases, which was caused by sludge formation in six cases, tumor ingrowth in four cases, and migration of the stent membrane in one case. During the follow-up period, there were no episodes of ascending cholangitis, acute pancreatitis, or bleeding.ConclusionsThe new metal stent with an S-shaped anti-reflux valve demonstrated a relatively long duration of stent patency. This was attributable to reductions in duodenobiliary reflux by the anti-reflux valve. Also, the stent with an S-shaped anti-reflux valve is technically feasible and very safe. However, further prospective, randomized comparison studies of stents with anti-reflux valves and conventional stents are needed to evaluate the duration of stent patency.© 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

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