Management of malignant biliary obstruction with self-expanding metal stents

Background: Self-expanding metal stents for the palliation of malignant biliary obstruction are used from the late 1980s. This report presents our own experiences.

Patients and methods: Between 2000 and 2004, 32 patients (17 women and 15 men) with a mean age of 73.2 years (range 45–94) with inoperable malignant biliary obstruction were treated with self-expanding metal stent via the endoscopic retrograde route at our institution. There were 15 cancers of pancreas, 4 cholangiocarcinomas, 6 gallbladder cancers with infiltration of common bile duct and hepatic duct, 2 papillary carcinomas and 5 cases of nodal compression due to secondary spread of other primary neoplasm. In 14 patients the distal, in 15 the middle and in 3 the proximal part of the common bile duct was obstructed. All patients were jaundiced and had elevated level of alkaline phosphatase. All patients underwent endoscopic sphincterotomy and 5 required bougienage prior to stent insertion.

Results: Stent implantation was successful in all patients, but in one case there was no suffitient biliary drainage. Technical problems: in two cases stent did not release and in one case the tip of the delivery catheter stuck into the mesh of stent during the closing and removal and the stent moved distally. Two bleedings occurred caused by tumor spreading to the duodenum and ventricular ulcer, but was not connected with stents and stenting procedure. Four stent occlusions occurred with recurrent jaundice and cholangitis. In these cases plastic endoprostheses were successfully placed trough the metal stent after washing of the biliary tract with saline. Stent occlusion time was between 2 weeks and 2.5 years, mean stent patency was 7.8 months. Mean survival was 7.1 months, 5 patients are still alive.

Conclusion: Metal stenting of malignant biliary obstruction regarded as a safe and reliable palliation.