7260 Effective management of malignant obstructive jaundice with polyethylene stents.

Abstract

Background: Malignant obstructive jaundice is a common management problem encountered in tertiary care center. Advanced age of the patients, late stage of diagnosis and preexisting medical illnesses favor endoscopic stenting via Endoscopic Retrograde Cholangiopancreatography (ERCP). However, due to financial limitation and short period of survival, polyethylene stents may be good enough to achieve drainage in these patients. Our aim was to study the effectiveness of polyethylene stents in the management of malignant biliary strictures. Methods: ERCP was done in all patients with suspected malignant obstructive jaundice based on clinical features, liver function tests, tumour markers and imaging studies. Following demonstration of biliary strictures, brushings were done for histology. Endoscopic stenting was done with 1 or more 10 French polyethylene stents by the conventional method. All patients were on regular follow up after successful stenting. Repeat procedures or stent exchanges were performed based on clinical and biochemical parameters suggestive of stent occlusion. Results: 55 consecutive patients (31 female, 24 male), mean age: 61 years (Range: 32-86) were included in the study. The types of malignancies included periampullary carcinoma (N=18), pancreatic carcinoma (N=22), cholangiocarcinoma (N=12) and porta hepatis secondaries (N=3). Nineteen patients had histological confirmation of tumours. Stenting was successful in 45 patients on first attempt giving an initial success rate of 82%. Seven patients were stented by the combined percutaneous-endoscopic method. The overall success rate of stenting was thus 95%. The mean duration of stent patency was 3.6 months. Repeated stent exchange was done for 16 patients. There was no procedure related mortality. Stent migration was seen in 2 patients and recurrent cholangitis in 1 patient. Four patients underwent palliative bypass surgery subsequently with a mean survival of 4.3 months. Sixteen stented patients later died from advanced malignancies during the study period with a mean survival of 5.7 months. Conclusions: Endoscopic stenting with economical polyethylene stents was an effective palliative treatment for malignant obstructive jaundice. It is the treatment of choice for patients with advanced disease, high surgical risk and limited life expectancy.