Abstract
Aims: Distal malignant biliary obstruction may be caused by various neoplasms, such as pancreatic cancer, ampullary tumors and cholangio-carcinoma. The endoscopic approach is more cost-effective than the operative approach. The use of plastic stents is nowadays recommended in patients with poor prognosis (less than 5–6 months). Initial endoscopic placement of a metal stent is a cost-saving strategy only in patients expected to survive longer than six months. Methods: Over a 6 - year period, from 2009 to 2014, a total of 458 endoscopic transpapillary interventions were analyzed. Results: 235 patients (51,3%) were treated for pancreatic head tumor, 122 patients (26,6%) - for papilla of Vater tumor, and 101 (22,1%) - due to distal cholangiocarcinoma. 32 patients (7.0%) had endoscopic treatment failure.Plastic prostheses were inserted in 218 (51.2%) patients, self-expanding metal prostheses - in 96 patients (22.5%), suprapapillary choledochoduodenostomy - in 112 (26,3%) cases. 38 (9%) patients had following complications of endoscopic treatment: bleeding into the digestive tract - 15 cases (3,5%), acute pancreatitis -6 cases (1,4%), bile duct perforation - 1 case (0,2%), stent migration - 7 (1.6%), early stent obstruction - 10 (2.3%) cases. All cases of pancreatitis were treated successfully with conservative therapy. 13 cases of bleeding stopped after endoscopic hemostasis, 2 - after endovascular embolization. In cases of early clogging of the prostheses and stent migration we performed an urgent stent replacement. The 30-day mortality rate was 0.7%, as a result of fatal septic conditions in three patients. Stent occlusion occurred after a mean of 285 days for the metal stent group vs 82 days for the plastic stent group. Conclusions: Endoscopic stent insertion is the modality of choice. It provides effective palliation and may offer lower morbidity and mortality, shorter hospital stay, and diminished overall cost compared with surgical or radiological approaches.
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