Prolonged patency with a new-design Teflon biliary prosthesis.

Clogging of biliary endoprosthesis has been a persistent problem faced by endoscopists over many years. Evidence suggests that incorporating sideholes increases the risk of plastic stents clogging. We conducted a prospective, nonrandomized study comparing 10 Fr Teflon pigtail (PT) stents with sideholes to a new design 10Fr Teflon straight stent without sideholes, designated as the "Tannenbaum" (TB) stent. Seventy-four consecutive patients were treated with the PT stent and 55 consecutive patients with the TB stent in two different periods. All patients had malignant distal biliary obstruction with jaundice. Stent insertion was successful in all patients, and a significant reduction in serum bilirubin levels was achieved. All follow-up patients, except one in the TB group, had died at the time of reporting. Median survival in the PT group was 100 days (range: 6-636 days) and 130 days (range: 3-703 days) in the TB group. Median follow-up in the PT group was 104 days (range: 6-636 days) and 141 days (range: 3-537 days) in the TB group. Statistical analysis shows significantly longer patency for the TB stent (p < 0.02). Moreover, the results of the TB stent compared favorably with the published results of metallic self-expandable biliary stents. We believe the TB stent holds great promise for the future of endoscopic biliary stenting. Prospective randomized studies comparing the TB stent with existing plastic and metal stents are, however, necessary.