Background: The biliary stents in current use have a tendency to be blocked. In order to maintain long-term patency of stent a larger diameter of biliary stent is needed and the expandable metal stents(EMS) have been developed. But tumor ingrowth was frequently observed in uncovered self-EMS. To overcome the limitations of uncovered self-EMSs, we developed self-EMS covered with polyurethane or polytetrafluoroethylene(PTFE) which was used as artificial vessel. This stent would have more advantages than uncovered self- EMS. Aim: To evaluate the successfulness and the effectiveness of new membrane covered self-EMS(covered modified-Gianturco biliary stent) with polyurethane or PTFE, we studied in patients with malignant biliary obstruction due to biliopancreatic carcinoma. Method: We developed self-EMS covered with polyurethane or PTFE, and applied covered self-EMS through endoscopic transpapillary or percutaneous transhepatic route in l8 patients of malignant biliary obstruction and 2 benign stricture. We followed-up the patients monthiy with ultrasonography, clinical symptoms and liver function test. There were 13 men and 7 women. The mean age in inrolled patients was 65.6¡¾7.9 year. 10 had CBD cancer, 7 pancreatic head cancer, 1 ampulla of Vater cancer, and 2 benign intrahepatic bile duct stricture. Results: The success rate of covered self-EMS insertion through peroral transpapillary route was 84.6%(11/13) on first trial. In 2 patients with malignant biliary obstruction we couldn't insert covered self-EMS because of technical problems in introducing system, but sucessfully inserted on second trial. And through the Percutaneous transhepatic route, we could also sucessfully applied covered self-EMS in all patients(7/7). There were no complications associated to the procedure of stent implantation. In one case the stent was dislodged spontaneously after 1.3 month, and one patient died after 1 month due to pulmonary metastasis. There was no evidence of biliary reobstruction during follow-up period d[median follow-up 6.75(l.312) months in PTFE patients(4) and 2(l 10) months in polyurethane patients(16)]. Conclusion: We expect that new membrane covered self-EMS has long-term patency and adequacy of biliary drainage, but we cannot completely evaluate the disadvantage of this stent until now due to short-term follow up.
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