Experiences with 89 biliary self expandable metal stents

Background: Pancreatobiliary malignancies usually cause biliary obstruction during their course. The palliative management of inoperable patients (pts) is relatively well established. In jaundiced pts without duodenal obstruction the endoscopic biliary drainage is the method of choice. The self expandable biliary metal stents have been proven as cost-effective solution of the malignant stricture in pts with relatively good (as many as 6 months) life expectancy.

Patients and methods: We have treated 89 pts with inoperable biliopancreatic tumors using self expandable metal stents (Microvasive/Gianturco uncovered stents) during the last 5 years. Localisation of the tumors were: 41 pancreatic, 31 choledochal/gallbladder, 9 papilla of Vater and 8 Klatskin-type cancers. We assessed the survival, stent patency, need for reinterventions and further oncologic treatment.

Results: Early (within 4 weeks) death occurred in 6 pts, mainly due to pulmonary embolism. Only 15 pts recieved chemotherapy later on. In the pancreatic tumor group 31/41 pts were followed, 19 pts died, 12 are alive. The median survival of pts was 100 (1–413) days, while stent patency was 74 (1–413) days. Previous plastic biliary drainage were performed in 14 cases. Further interventions were needed after metal stent insertion in 10 pts, 7 of them presented with stent occlusion, 3 had duodenal obstruction, which required surgery or endoscopic intestinal stenting. In the biliary tumor group in the followed 26/31 pts the median survival was 200 (10–2070) days, the patency was 198 (13–559) days. Previous biliary drainage was applied in 12 pts. Reinterventions included restenting in 7 pts and gastro-entero anastomosis in 3. Seven of 9 pts with papilla tumor and 7/8 of Klatskin tumors were followed. The median survival and stent patency were 254, 254 and 72, 72 days, respectively. Four reinterventions were necessary in these groups.

Conclusions: The survival proved to be poor in the pancreatic and Klatskin tumors. More pts should recieve chemotherapy with pancreatic tumor. Anticoagulation should be taken into consideration among these pts with obvious hypercoagulability. Altogether 32.9% (24/73 followed) of pts needed further palliative interventions (mainly restenting) during their remaining life.