Palliative Treatment of Malignant Biliary Obstruction Using Self-expandable Metallic Stents: Long-term Clinical Results

This study is conducted to evaluate the clinical efficacy of different self-expandable metallic stents for palliative treatment of malignant biliary obstruction. The pros and cons of each stent design were compared. Forty-eight self-expandable metallic stents were used in 42 patients (pancreatic tancer, n = 11; cholangiocarcinoma, n = 9; ampulla of Vater cancer, n = 7; common bile duct cancer, n = 4; gallbladder cancer, n = 2; metastases, n = 9). Sixteen patients (38%) had previously undergone hepato-biliary and gastric surgery. Pathologic confirmation as malignant was done in 15 patients (36%). All patients underwent percutaneous transhepatic biliary drainage except three patients who had a matured T-tube tract placed during surgery. Stent placement was successful in all patients. Thirty-five patients (85%) were treated with a single stent, while six (15%) needed two stents. One patient had bilateral drainage and twenty-two had stents crossing the ampulla of Vater. Two patients had transient acute pancreatitis and four patients had right upper quadrant abdominal pain, which subsided after conservative treatment. Three patients had cholecystitis after prostheses placement. The re-intervention rate was 24% (n = 10) as follows: percutaneous transhepatic biliary drainage n = 4; percutaneous transhepatic gallbladder drainage n = 2; endoscopie retrograde cholangiography n = 4. Overall stent patency ranged from 3 to 780 days (mean, 183 days), with mean survival of 184 days. In conclusion, our results show that the use of metallic stents is effective in the palliation of obstructive jaundice. The newly developed Memotherm self-expanding, non-shortening metallic stent is easier to insert accurately.