Endoscopic Biliary Stenting for Malignant Obstructive Jaundice

Abstract

Aim. To identify opportunities for endoscopic retrograde biliary stenting for malignant obstructive jaundice and to compare long-term results of stenting using plastic and self-expanding metal stents. Material and Methods. We analyzed the results of endoscopic methods of di-agnostics and treatment of inoperable patients with malignant obstructive jaundice, as well as incidence of early and late complications of biliary stenting as the final treatment. Total number of patients were 160 people which were divided into 2 groups by 80 patients. In the 1st group plastic biliary stents with the diameter of 3–3.5 mm (10–11.5 Fr) were used for bile ducts drainage. In the 2nd group covered self-expanding metal stents with the diameter of 10 mm (28–30 Fr) were applied. All patients underwent a comprehensive diagnostic program including traditional ultrasound (US), computer tomography (CT), EUS (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP). Results. Early postoperative complications were observed in 7 (8.7%) and 5 (6.7%) patients in the 1st and 2nd group respectively. Remote complications such as recurrent obstructive jaundice and/or cholangitis in various time periods after discharge occurred 2 times more often in the 1st group (28 out of 80 patients) than in the 2nd group (12 out of 80 patients) that required repeated hospitalizations and re-stenting. Malignant duodenal stenosis arose in 20 (12.5%) patients. Average time was 8.2 months. Conclusion. Endoscopic retrograde stenting can be used as an effective final method of bile ducts decompression in patients with inoperable pancreatobiliary tumors complicated by obstructive jaundice. The term of plastic biliary and self-expanding metal stents function was 119.9 ± 131.4 days (4 months) and 257.5 ± 91.3 days (8.6 months) respectively. Improvement of equipment and tools, use of antegrade techniques combined with EUS-guided interventions, pyloroduodenal self-expanding stents allow to bypass pre-existing limitation with duodenal neoplastic stenosis.