Pancreatic Neoplasms Clinical Trial
Official title:
RCT Steel (Wallstent®) vs Nitinol (Wallflex®) Bile Duct Stent for Palliation of Malignant Obstruction
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.
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.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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