7264 Clinical outcome of percutaneous-duodenal bile duct stent of the yamakawa type.

Abstract

Introduction: In case of obstructive jaundice and failure of endoscopic stenting percutaneous transhepatic cholangio-drainage (PTCD) as well as Yamakawa stents are able to decompress intrahepatic bile ducts. Yamakawa stents are deployed percutaneously and unlike PTCD are advanced further through the tumor stenosis into the duodenum allowing internal bile drainage. Only in case of stent dysfunction, the percutaneous Yamakawa outlet has to be opened enabling immediate percutaneous bile drainage as well as subsequent clearing of stent occlusion. Since Yamakawa stents allow intracorporal bile drainage into the duodenum collecting bags are avoided and bile loss syndrome is prevented. Aim: We studied the clinical outcome of Yamakawa stents in pat. with malignant jaundice. Methods: During the last two years (from 8/97 to 11/99) we treated 827 pat. suffering from malignant jaundice in our clinic. In 8.2% (68/827) of cases endoscopic stenting was impossible or insufficient. These pat. receive either PTCD or Yamakawa stents (8 to 14 Fr., Pflugbeil Co., Germany). Results: In 68 pat. we performed percutaneous decompression of malignant jaundice. 62 pat. received PTCD. Later on, we exchanged PTCD to Yamkawa stent in 28 (45.2%) pat.. 6 further pat. had primarily received Yamakawa stents. Finally, we managed a total of 34 Yamakawa stent patients (20 male, 14 female, mean age: 69.2 years, range: 33-94 years). Pat. with Yamakawa stents suffered from gastric cancer (n=7), pancreatic cancer (n=7), Klatskin tumor (n=9), gall bladder cancer (n=4) and 7 metastases of distant tumors. Yamakawa stenting significantly reduced cholestasis (bilirubin < 2 mg/l). Complication related to Yamakwa stenting occured in terms of percutaneous bleeding (n=2), bilioma (n=3), pleural fistula (n=1), cholangitis (n=2) and hemobilia (n=1). All complications were moderate, conservatively treated without procedure related mortality. During the follow up 38% (13/34) pat. died due to tumor progress (follow up: 3.5 months, range: 2-8 months). Furthermore, 62% (20/34) of pat. are still alive (follow up: 6.8 months, range: 1-24 months). Discussion: Yamakawa stents compared to PTCD offer higher comfort and improved quality of life to pat. suffering from malignant jaundice. Physiological bile drainage can be achieved by Yamakawa stents avoiding bile loss syndrome. Futher advantageous are increased pat. comfort as well as easier stent maintainance in case of stent occlusion. Conclusively, we recommend to replace PTCD by Yamakawa stents whenever possible.