Efficacy of Metallic Stent Placement in Patients with Malignant Hilar Obstruction

Abstract

Backgrounds: In patients with unresectable malignant hilar obstruction, endoscopic stent placement was used to maintain adequate biliary drainage and relieve symptoms. Even though comparisons of the efficacies between metallic and plastic stents in obstructive jaundice have been reported, the usefulness of metallic stents and bilateral drainage in hilar obstruction are still controversial. Aims: The aims of this study were to assess the efficacy of metallic stent in malignant hilar obstruction and to evaluate the unilateral drainage using uncovered metallic stent in these patients. Methods: Sixty four cases of unresectable malignant hilar obstruction receiving endoscopic metallic stent placement between September 1999 and June 2003 were retrospectively reviewed. Stent success rate of stenting, efficacy of drainage, early complications (within 30 days of stent placement), rate of stent failure and duration of stent patency were analyzed. Results: Of the 64 patients (34 men, 30 women; mean age 62.4 [12.4] years), 18 had Bismuth type I, 7 had Bismuth type II, 14 had Bismuth type III, and 25 had Bismuth type IV lesions. Extrahepatic bile duct cancer was 36 cases, gallbladder cancer 19, and metastatic cancer involving extrahepatic biliary trees 9. Successful stent placement and drainage were achieved in 62 of 64 (96.9%) and 57 of 64 (89.1%) patients, respectively. Cholangitis as early complication was developed in 2 (3.1%) cases and stent occlusion occurred in 21(33.8%) patients. Follow up duration was 205 [223] days. Median stent patency was 114 days and median patient survival was 124 days. There were no significant differences in efficacy of metallic stent according to Bismuth classification. Of 37 patients with Bismuth Type III/IV, 32 patients received unilateral stent placement and 5 patients bilateral stent placement. Patients with bilateral stent placement had a tendency of more rapid serum bilirubin decrease but there was no statistical significance and stent patency was not significantly different between both groups. Conclusion: Metallic stent placement in patients with unresectable malignant hilar obstruction is safe and effective for biliary drainage. Backgrounds: In patients with unresectable malignant hilar obstruction, endoscopic stent placement was used to maintain adequate biliary drainage and relieve symptoms. Even though comparisons of the efficacies between metallic and plastic stents in obstructive jaundice have been reported, the usefulness of metallic stents and bilateral drainage in hilar obstruction are still controversial. Aims: The aims of this study were to assess the efficacy of metallic stent in malignant hilar obstruction and to evaluate the unilateral drainage using uncovered metallic stent in these patients. Methods: Sixty four cases of unresectable malignant hilar obstruction receiving endoscopic metallic stent placement between September 1999 and June 2003 were retrospectively reviewed. Stent success rate of stenting, efficacy of drainage, early complications (within 30 days of stent placement), rate of stent failure and duration of stent patency were analyzed. Results: Of the 64 patients (34 men, 30 women; mean age 62.4 [12.4] years), 18 had Bismuth type I, 7 had Bismuth type II, 14 had Bismuth type III, and 25 had Bismuth type IV lesions. Extrahepatic bile duct cancer was 36 cases, gallbladder cancer 19, and metastatic cancer involving extrahepatic biliary trees 9. Successful stent placement and drainage were achieved in 62 of 64 (96.9%) and 57 of 64 (89.1%) patients, respectively. Cholangitis as early complication was developed in 2 (3.1%) cases and stent occlusion occurred in 21(33.8%) patients. Follow up duration was 205 [223] days. Median stent patency was 114 days and median patient survival was 124 days. There were no significant differences in efficacy of metallic stent according to Bismuth classification. Of 37 patients with Bismuth Type III/IV, 32 patients received unilateral stent placement and 5 patients bilateral stent placement. Patients with bilateral stent placement had a tendency of more rapid serum bilirubin decrease but there was no statistical significance and stent patency was not significantly different between both groups. Conclusion: Metallic stent placement in patients with unresectable malignant hilar obstruction is safe and effective for biliary drainage.