RCT Steel (Wallstent®) vs Nitinol (Wallflex®) Bile Duct Stent for Palliation of Malignant Obstruction
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 400
- 试验地点
- 11
- 主要终点
- confirmed stent failure
研究概览
简要总结
Less than 20% of patients with malignant distal bile duct (BD) obstruction (often pancreatic cancer) are suitable for resection surgery.In the rest,palliation treatment comes into focus. Jaundice caused by BD obstruction gives pain, infection (cholangitis), often itching and increased weight loss, and the patient is stigmatized by the deep yellow colour of the skin.Therefore palliation with endoscopic stenting by ERCP-technique is important. Modern self-expanding metal stents (SEMS) are now widely used in this context. Comparison in a RCT between steel and nitinol SEMS has never been performed.
The steel stent (Wallstent®) is the "original",is widely used, and has more expanding power. Nitinol stents are softer and claimed to be easier to insert,and are more and more popular.A newly developed nitinol stent (Wallflex®)may have these advantages, but is some 120 Euros more expensive.
Regarding the most important outcome measure, time to stent failure (obstruction), no one knows if there is any difference.Our hypothesis is that there is no difference in this main outcome endpoint.
详细描述
Secondary outcome measures (compare above) are complications caused by the stent or stent insertion and technical ease to insert the stent. To discover a 12% difference between the 2 groups, regarding patency, 400 patients must be included in the trial, alfa 0.05, beta 0.8. Investigators know from previous trials (Single center trial South Hospital GIE 2006;63:986-995 and a newly finished similar swedish multicenter trial,prel data DDW- 09)that the 9 hospitals recruited will be able to include this no of patients in approximately 2.5 years.
Investigators will have a shortest follow-up period of 10 months, followup will be by phone with standard questions connected to stent failure, which is defined clinically AND by a new ERCP with intervention because of an obstructed stent.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •pt more than 20yrs.
- •BD stenosis at least 2cm distal of the hepatic hilum, with typical malignant exposure radiologically.
- •Clinically in accordance with tumour.s-bilirubin more than 50 micromol per litre.
- •Radical surgery probably not possible(temporary-1month-plastic stenting for further investigation and then exchange to SEMS if estimated non-operable, after Rx is allowed).
- •The patient must be fully informed by his doctor orally and in writing prior to the procedure, and give her/his informed consent. Ultrasound or CT examination must be performed prior to Rx.
排除标准
- •Informed consent not obtained.
- •Significant multiple intrahepatic stenosis by multiple tumour growth, not suitable for ERCP stenting.
- •Radical Surgery will probably take place. Suspicion of non-malignant obstruction-further investigation must be performed.
- •Not possible by anatomical reasons to reach the papilla, i.e because of prior operations.
- •prior BD stent inserted (metal stent or plastic stent >1month).
- •Previously included in this trial. Prothrombin index more than 1.
- •(normal <1.1).
研究组 & 干预措施
steel
Insertion of Metalic Steel Stent, Wallstent® in malignant distal bile duct obstruction
干预措施: Steel (Device)
Nitinol
Insertion of Metalic nitinol Stent, Wallflex® in malignant distal bile duct obstruction
干预措施: Nitinol (Device)
结局指标
主要结局
confirmed stent failure
时间窗: 300 days follow up
次要结局
- Survival(300 days)
- safety with respective stent in trial at insertion and afterwards(complic.)(300 days)
研究者
claes soderlund
Stockholm South General Hospital
Stockholm South General Hospital