Metal Stents and Biliary Obstruction Secondary to Lymphoma: A Tale of Caution

Abstract

We read with great interest the recent article by Ross et al. [1] reporting one cancer center’s experience with the treatment of obstructive jaundice in patients with lymphoma. This article describes outcomes for 35 patients who underwent biliary decompression endoscopically or percutaneously; biliary stents were placed in 43 of the 50 ERCP’s completed, and all but four of these stents were plastic. As quoted by Ross et al. [1], the need for a permanent metal stent in cases of biliary obstruction secondary to lymphoma is less prevalent given the increased chemoresponsiveness of many lymphomas when compared to other more refractory types of malignant biliary obstruction. The authors conclude that metal stents should be reserved for patients with lymphomas refractory to treatment who are expected to live more than 6 months. Based on experiences at our institution, we fully agree with the placement of plastic biliary stents for obstructive lymphomas, but would also urge more caution when considering uncovered metal stent placement in these cases, given the potential complications which can ensue due to the difficult (if not impossible) removal of such stents. We have two cases that illustrate this point.