Antegrade biliary stenting for obstructive jaundice

Abstract

Objective. To determine the role bile duct stenting with self-expandable metallic stents in the treatment of malignant obstructive jaundice. Material and methods. Eight-year experience of palliative antegrade stenting with self-expandable metallic stents was analyzed. There were 218 patients with malignant obstructive jaundice. Distal and proximal obstruction was diagnosed in 118 (54%) and 100 (46%) patients, respectively. We have used self-expandable metallic covered, partially covered and bare-metal stents with diameter of 10, 8 and 6 mm and length of 40, 60 and 80 mm. Results. Technical success in antegrade two-stage installation of self-expandable stents have been achieved in 208 (99%) patients. There were 230 deployed self-expandable metallic stents. Seven (3%) patients underwent simultaneous stenting of right and left hepatic ducts and confluence area with bare-metal stents. Stenting of right or left hepatic ducts and confluence area with partially covered stents was carried out in 34 (16%) patients. Other 59 (27%) patients with proximal biliary obstruction and no separation of lobar bile ducts underwent stenting with 27 partially covered and 31 covered stents. Distal obstruction was managed by using of covered stents as a rule (63%). Complications after antegrade biliary stenting occurred in 29 (13%) patients. Conclusion. Antegrade biliary stenting with metallic self-expandable stents is effective and minimally invasive approach. Moreover, it is comparable with conventional palliative interventions aimed at bile outflow recovery.