Percutaneous Biliary External–Internal Drainage for Malignant Obstruction of Self-Expanding Uncovered Metal Stents Placed for Hilar Carcinoma: Retrospective Analysis of Long-Term Outcome in 160 Patients

Abstract

Aims and Objectives We evaluated the safety and effectiveness of reestablishing adequate bile flow in patients with malignant obstruction of multilobar self-expanding uncovered metal stents (SEUMSs) inserted for palliative treatment of malignant hilar stenosis, an otherwise fatal setting. From September 1991 to January 2019, 160 patients (100 men and 60 women; median: 69 [range: 37–87] years) with malignant obstruction of multilobar SEUMSs were treated by percutaneous transhepatic external–internal biliary drainage. All patients were followed in their respective oncology services where they were treated (or not) according to local protocols adapted to their disease and overall general status.

Result External–internal biliary drainage was successful in all 160 patients. All patients were discharged within 5 days. Both immediate (4 patients; 2.5%) and late complications (29 patients; 18%) were managed successfully with minimal morbidity and no mortality. After reestablishment of adequate bile flow, the median survival was 191 days (range: 2–5,668 days). Forty-one (25.6%) patients survived for more than 12 months, and 10 (6.2%) survived for more than 3 years.

Conclusion In our series, external–internal biliary drainage was safe and effective; it was life-saving and afforded acceptable quality of survival for patients who otherwise would have been left untreated with short-term fatality.

Keywords

percutaneous biliary stent - bile duct malignancy - hilar carcinoma - biliary stent obstruction

Publication History

Article published online:
14 April 2020

• References

• 1 Molina V, Sampson J, Ferrer J. et al. Klatskin tumor: diagnosis, preoperative evaluation and surgical considerations. Cir Esp 2015; 93 (09) 552-560
• 2 Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003; 238 (01) 84-92
• 3 Hong W, Zhu Y, Dong Y, Wu Y, Zhou M, Ni H. Predictors for occlusion of the first inserted metallic stent in patients with malignant biliary obstruction. Saudi J Gastroenterol 2015; 21 (06) 386-390
• 4 Lee BH, Choe DH, Lee JH, Kim KH, Chin SY. Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR Am J Roentgenol 1997; 168 (03) 741-745
• 5 Bonnel D, André T, Mader B, Lefebvre JF, Bensoussan E, Liguory C. Malignant biliary obstruction, general review and clinical practice [in French]. Bull Cancer 2013; 100 (05) 443-452
• 6 Deoliveira ML, Schulick RD, Nimura Y. et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 2011; 53 (04) 1363-1371
• 7 Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology 1978; 74 (03) 554-559
• 8 Sawas T, Al Halabi S, Parsi MA, Vargo JJ. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82 (02) 256-267.e79
• 9 Moole H, Jaeger A, Cashman M. et al. Are self-expandable metal stents superior to plastic stents in palliating malignant distal biliary strictures? A meta-analysis and systematic review. Med J Armed Forces India 2017; 73 (01) 42-4810
• 10 Li J, Li T, Sun P, Yu Q, Wang K, Chang W, Song Z, Zheng Q. Covered versus uncovered self-expandable metal stents for managing malignant distal biliary obstruction: a meta-analysis. PLos One 2016; 11 (02) e0149066
• 11 Cwikiel W. Percutaneous management of occluded biliary duct endoprostheses. Acta Radiol 2000; 41 (04) 338-342
• 12 Inoue T, Naitoh I, Okumura F. et al. Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction. Dig Endosc 2016; 28 (07) 731-737
• 13 Lazaridis KN, Gores GJ. Primary sclerosing cholangitis and cholangiocarcinoma. Semin Liver Dis 2006; 26 (01) 42-51