4654 Biliary tube stents without sideholes and expandable metallic stents equally relieve middle and lower biliary tracts.

Abstract

Background/Aim: The low cost and ease of handling of biliary plastic tube stents has led to their extensive use, however clogging of stents remains a major problem. While biliary expandable metallic stents (EMS) improved patency, they are unsuitable for primary biliary stenting because of their high cost and difficulty in replacement. Recently, biliary tube stents without sideholes were also reported to prolong patency. To evaluate the clinical utility and relative advantages of three types of biliary stents, we reviewed clinical results of three types of stents, including; 1) plastic tube stents with sideholes (PWS), 2) plastic tube stents without sideholes (PWOS) and 3) EMS. Patients and methods: 128 patients (M:F=72:56,mean age 69 years, range 34-91) consisting of 52 with pancreatic cancer, 24 with gallbladder cancer, 22 with biliary cancers, 18 with metastatic lymph nodes, 4 with Vater papilla cancer, and 8 with other malignant diseases. PWS (10 Fr), PWOS (double layer stents, Olympus, 10Fr or Soehendra tannenbaum stents, Wilson Cook, 10Fr), and EMS (Boston scientific, 30Fr) were inserted in 65, 25, and 38 cases, respectively. Cumulative stent patency of each stent was analyzed with Kaplan-Meier method, supplemented by Wilcoxon's method. Medical costs of each stent insertion were compared(as $1=105yen). Results: PWS and PWOS were inserted as the primary stenting whereas EMS were inserted as the secondary in all cases.Overall cumulative stent patency rates of EMS and PWOS were significantly higher than that of PWS, and their patency rates at 50, 100, and 200 days were: EMS; 94, 81, and 66%, PWOS; 95, 87, and 39%, and PWS; 70, 41, and 31%. In middle and lower biliary tract strictures, patency of EMS and PWOS were significantly higher than that of PWS, and their patency rates were: EMS; 93, 80, and 63%, PWOS; 94, 86, and 46%, and PWS; 77, 54, and 43%. In the cases with pancreas cancer, cumulative patency rates of EMS and PWOS were significantly higher than that of PWS. These patency rates were: EMS; 94, 72, and 60%, PWOS; 90, 90, and 61%, and PWS; 63, 49, and 37%. In Japan, PWS, PWOS, and EMS cost $24, $133, and $2,286, respectively and ERCP costs $721. Then the costs divided by mean patent period of PWS, PWOS, EMS were $9.3, $7.9, and $19.6/day, respectively. Conclusion:We recommend PWOS for the primary biliary stenting in the middle and lower biliary stricture, especially those due to pancreatic cancer, based on its lower price and sufficient patency without replacement after diagnoses of inoperability.