Evaluation of different percutaneous modalities for managing malfunctioning biliary stents

Abstract

BackgroundThere is no consensus regarding optimal management of biliary metal stent occlusion. AimTo evaluate the efficacy of different percutaneous methods for managing biliary metal stent occlusion. Patients and methodsThirty-eight patients were included in the study. Metal biliary stent occlusions were managed by insertion of another metal stent in 18 patients (group 1), insertion of an internal–external catheter in 15 patients (group 2), and mechanical cleaning in 5 patients (group 3). ResultsThe clinical success was achieved with bilirubin decreased from 16.0 (7.5–34.3) to 4.1 (1.2–5.7)mg/dl (p<0.05) with no significant differences among all groups. No major complications occurred. The median duration of metal stent patency was 75days (43–107) after insertion of another metal stent (group 1), 90days (71–109) after insertion of plastic internal–external catheters (group 2), and 54days (30–68) after mechanical cleaning (group 3) with no significant difference. Incremental cost effective analysis showed that plastic internal–external catheters insertion is the most cost effective option. ConclusionAlthough the three methods are equally effective in managing an occluded metal stent, the most cost effective method appears to be plastic internal–external catheters insertion.