Self-expandable metal stent using in pancreatico-biliary malignancie

Background: In the past decades, endoscopic stenting became a basic approach in the treatment of pacreatico-biliary stenoses. The type of the stent depends on the etiology of the stenosis. Self-expandable metal stents (SEMS) are preferred in malignant processes.

Methods and results: From 2001, we treated 23 patients (average age: 70.2 years [27–84]; male/female ratio: 12/11) with SEMS. The stenoses originated from pancreatic head-, cholangio-, cholecysto-, Vater papilla carcinomas or metastasis (15, 4, 2, 1 or 1 cases, respectively). The mortality rate was 15/23 following. Among the 15 lost patients, the average survival time was 4.2 months (4–13 months) after SEMS implantation, specifically, 4.0 months in pancreatic head neoplasms, and 0.5, 1.0 or 13 months in three cholangio-carcinomas. We still observe the remaining 8 patients, where the average follow-up time has been 3.2 months. Among all the 23 cases: 1./ the average survival time was 6 months after SEMS implantation; 2./ the occlusion of SEMS developed in 4 cases (average occlusion time: 9.5 months), where we inserted successfully a plastic stent into the occluded lumen of SEMS; 3./ neither SEMS-originated complication nor SEMS-dislocation could be observed. In 5 out of 23 cases: we initiated the treatment of malignant stenoses with polyethylene stents, where, because of restenosis, concurrent endoscopic interventions (mean frequency: 2.3/patient [1–3]) were needed in 2.5-months average intervals.

Conclusion: SEMS implantation seems to be a good alternative choice besides of surgical palliation of malignant pancreatico-biliary stenoses. The cost-benefit ratio is lower by using SEMS instead of plastic stents. The stent-in-stent method is successful in the management of occlusion of SEMS.