platic stents vs. SEMS vs. covered SEMS
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At last, a decision has been made and one that will solve the problem in re: to constant stent changes. That is great news, dear Imcherry. I don’t recall any posting addressing the logistic of plastic stent removal combined with insertion of a catheter, but hopefully someone else can chime in and help you out. But you have a valid question; surely and if asked, the physician will answer. Additionally, I will forward your posting to our Karen, oncology nurse. Hopefully she can get back to us within a day or two.
Hugs,
MarionAfter much discussion among endoscopists at my treatment center, the consensus was that I was after all not a good candidate for a covered metal stent due to the location of the biliary stricture. Because the plastic stents are not working well any more and are increasing difficult to insert (for an unrelated reason), they are now recommending external/internal drainage, where a tube will descend into the duodenum at one end, move up through the biliary duct, and go transcutaneously to the outside of the body on the other end. They tell me that most/all drainage usually occurs internally, so that the external opening can be capped off after a few days, rather than having to wear a bag there. What I don’t know yet, and haven’t been able to find on reports here: 1. Can the current plastic stent be removed during the same procedure as the insertion of the internal/external drainage catheter? 2. How do overall success rates compare for the two approaches to biliary draining? 3. How long can I expect the internal/external catheter to remain usable?
First and foremost I am hoping for others to come forward and share his/her personal experience with us.
In the meantime though you may want to use the Search function by entering the key words: metal stent.
Overall and based on my recollection of previous reports, the majority of patients reported few problems with covered SEMSs. There had been discussions of stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge, but a second stent insertion or mechanical cleaning appeared to have solved the problem. The overall of benefit of metal stent longevity by far superseded the inconvenience and discomfort of frequent plastic stent replacement.I know you wish for someone to share first hand experience and I hope for that someone to be so kind and help you out.
Hugs,
MarionI have now had 8 plastic stents inserted by ERCP over the last 14 months. The last two lasted only about 28 days before needing replacement. My doctors are now recommending that we switch to a metal stent. I am very interested in a covered SEMS, but there is concern that these may have an unacceptably high frequency of migration. There appears to have been some re-engineering done over the last year or two to try and mitigate this problem.Does anyone have any direct experience with these?
How about non-covered SEMSs? How long have they lasted? What has been done to restore their patency after they become clogged (e.g., clean them out, re-stent with metal, re-stent with plastic) and how successful has that been?
Any information appreciated.
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