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Efficacy and Cost Analysis of Plastic Stent Compare to Metallic Stent in Hilar Cholangiocarcinoma

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ClinicalTrials.gov Identifier: NCT00721175
Recruitment Status : Completed
First Posted : July 23, 2008
Results First Posted : December 23, 2011
Last Update Posted : December 23, 2011
Sponsor:
Information provided by (Responsible Party):
Apichat Sangchan, Khon Kaen University

Brief Summary:
The purpose of this study is to compare the adequacy of unilateral endoscopic biliary drainage using metallic stent with plastic stent in unresectable, complex, hilar, cholangiocarcinoma and cost analysis.

Condition or disease Intervention/treatment Phase
Hilar Cholangiocarcinoma Device: biliary stent (self expandable metallic stent) Device: PS Phase 4

Detailed Description:

There are two types of biliary stents: 1) the plastic stent made from polyethylene or polytetrafluoroethylene; and, 2) the metal stent braided in the form of a tubular mesh from surgical-grade stainless steel alloy and designed to expand to a maximum diameter of 10 mm. The main drawback of the plastic stent is the relatively high occlusion rate, but its advantage is the lower cost. The use of a metal stent for hilar tumor has many theoretical advantages: 1) the flexible open-mesh design should allow drainage of secondary duct branches; and, 2) its larger diameter may provide better drainage and longer patency (~3-9 months).

Whether one type of stent is superior in terms of adequacy of drainage or cost-effectiveness remains undefined. Therefore, we would conduct this study to assess the efficacy of drainage of endoscopically-inserted, unilateral, plastic stents vs. metallic stents in unresectable, complex, hilar cholangiocarcinoma patients.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 108 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Cost Analysis of Plastic Stent Compare to Metallic Stent in Unresectable Complex Hilar Cholangiocarcinoma; a Randomized Controlled Trial
Study Start Date : November 2007
Actual Primary Completion Date : April 2010
Actual Study Completion Date : September 2010

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: SEMS
self-expandable metal stent group
Device: biliary stent (self expandable metallic stent)
metallic stent was inserted into right or left hepatic duct which was planed before intervention using CT scan or MRCP
Other Name: self expandable metallic stent

Active Comparator: PS
plastic stent group
Device: PS
plastic stent was inserted into right or left hepatic duct which was planed before intervention using CT scan or MRCP
Other Name: Amsterdam type plastic stent




Primary Outcome Measures :
  1. Proportion of Patients With Adequate Biliary Drainage in Metallic Stent and Plastic Stent Group.(ITT Analysis) [ Time Frame: at 2 weeks and 4 weeks after stent insertion ]
    Successful drainage was defined as a decrease in total bilirubin level to less than 30% or 50% of pretreatment level within two and four weeks respectively in each patient.

  2. Proportion of Patients With Adequate Biliary Drainage in Metallic Stent and Plastic Stent Group.(Per Protocol Analysis) [ Time Frame: at 2 weeks and 4 weeks after stent insertion ]
    Successful drainage was defined as a decrease in total bilirubin level to less than 30% or 50% of pretreatment level within two and four weeks respectively.


Secondary Outcome Measures :
  1. Patients Survival Times [ Time Frame: until patient died or 6 months after the last patient was enrolled ]
    survival times of the patients after the first stent insertion

  2. Cost Effective Ratio of Metallic and Plastic Stent [ Time Frame: until the patients expire (Markov model) ]
    cost per quality adjusted life year (QALY)of metallic stent and plastic stent calculated from Markov model using transitional probabilities, cost and utilities from this study and the available literature



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Unresectable complex hilar cholangiocarcinoma which diagnosis and staging based on computed tomography(CT) or magnetic resonance cholangiopancreatography (MRCP)

Exclusion Criteria:

  • Patients with ASA 4 or 5
  • Patients with liver failure.
  • Patients unable to comply with follow-up

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00721175


Locations
Thailand
Srinagarind Hospital. KhonKaen University.
Muang, KhonKaen, Thailand, 40002
Sponsors and Collaborators
Khon Kaen University
Investigators
Principal Investigator: apichat sangchan, MD Department of Medicine. Faculty of Medicine. KhonKaen University

Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Apichat Sangchan, Assist. Prof., Khon Kaen University
ClinicalTrials.gov Identifier: NCT00721175     History of Changes
Other Study ID Numbers: HE500636
First Posted: July 23, 2008    Key Record Dates
Results First Posted: December 23, 2011
Last Update Posted: December 23, 2011
Last Verified: November 2011

Keywords provided by Apichat Sangchan, Khon Kaen University:
biliary stent
plastic stent
metallic stent
Complex hilar cholangiocarcinoma (Bismuth type II,III,IV)

Additional relevant MeSH terms:
Cholangiocarcinoma
Klatskin Tumor
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms