Prospective Evaluation of Stent Patency in Patients With Benign Biliary Obstruction of the Wing Biliary Stent (Viaduct™)
Prospective Evaluation of Stent Patency in Patients With Benign Biliary Obstruction of the Wing Biliary Stent (Viaduct™)
Endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement for
 resolution of biliary obstruction has been the method of choice for many years. However,
 stent clogging/obstruction is a major limitation in the management of biliary obstruction.
 Studies have shown that the conventional tubular type polyethylene stents (CS) with side
 holes accumulate significant sludge and their mean patency is approximately 90 days.

 Thus patients requiring longer term stenting need to undergo stent exchanges every 2-3
 months.

 Recently, a stent with a star-shaped cross-section has been developed for biliary
 applications. This FDA approved biliary Wing stent (WS) (ViaDuct™) is a novel plastic biliary
 stent that lacks a lumen, and is designed to allow bile to flow on the outside of the stent.
 The stent which is star shaped in cross section, channels fluid along its winged perimeter.
 It has been proposed that the winged stent design with a lack of central lumen obviates the
 risk of luminal occlusion and that the risk of occlusion, given the presence of multiple
 external drainage channels, is smaller. Longer term biliary drainage without the need for
 stent exchange should therefore be possible with these stents.

 The primary aim of this study is to prospectively evaluate the patency rate of the WS up to
 90 days in 50 patients with biliary obstruction due to stones or benign strictures.
1. Fifty patients that meet all the inclusion criteria and have none of the exclusion
 criteria will be invited to participate in the study.

 2. Initial visit:

 -  Written informed consent will be obtained

 -  Complete history and physical will be performed and the patients baseline liver
 function tests and imaging results will be assessed and noted in the case report
 form.

 -  Patients gender, date of birth, concomitant medications will be noted.

 3. Procedure:

 Patients will then be scheduled for the ERCP procedure with wing biliary stent
 placement. They will undergo the ERCP as standard of care and the wing biliary stent
 will be placed for decompression of the obstructed biliary system in situations where
 stenting is standard of care. One or more biliary stents may be placed during the
 procedure depending on the indication such as a biliary stricture necessitating multiple
 stent placements for dilation as the standard of care.

 4. Bloodwork:

 Patients will undergo bloodwork (total and direct bilirubin, alanine aminotransferase,
 aspartate aminotransferase, alkaline phosphatase) one week after the procedure. The
 degree of drop in bilirubin will also be noted. The patients will be then have these
 labs drawn again at 4, 8 and 12 weeks after the procedure.

 5. Telephone calls:

 The patients will be called on the telephone at weeks 2, 4, 6, 8, 10 after the procedure
 to monitor their clinical status. Patients and family members will be given a contact
 number to call us immediately if they develop any signs of biliary obstruction such as
 fever, abdominal pain, jaundice, dark urine or light stools. They will also be
 instructed to come to the emergency room should they develop fevers.

 6. Stent removal:

 At the end of 90 days from the stent placement patients will return for a repeat ERCP
 for stent removal as the standard of care and further endo-therapy as indicated.

 7. Stent patency will be calculated from the time of stent insertion up to the end of 90
 days. The stent patency rate at 90 days will be the proportion of stents placed that do
 not occlude over this time period. Stent occlusion will be defined as biochemical or
 clinical evidence of obstructive jaundice.

 8. All the continuous and outcome variables (stent obstruction) will be statistically
 analyzed and stent malfunction rates will be analyzed for the wing stent across the
 various indications.
Inclusion Criteria:

 -  All patients age 18 or older referred for ERCP for biliary obstruction from stones or
 benign strictures that have been confirmed based on clinical, laboratory and imaging
 findings, with an indication for plastic stent placement.

 One or more biliary stents may be placed during the procedure depending on the indication
 such as a biliary stricture necessitating multiple stent placements for dilation as the
 standard of care.

 -  Expected patient survival of at least 90 days

 -  High likelihood of patient follow-up

 -  Patient is able to give a written informed consent

 -  Patient is willing and able to comply with the study procedures.

 Exclusion Criteria:

 -  Patients with cholangitis

 -  Patients with bile leak

 -  Pregnant patients

 -  Patients with any contraindication to endoscopic procedure

 -  Participation in another investigational study that may directly or indirectly affect
 the results of this study within 30 days prior to the initial visit

 -  Patients with malignant biliary strictures