Percutaneous Palliation of Malignant Obstructive Jaundice with the Wallstent Endoprosthesis: Follow-up and Reintervention in Patients with Hilar and Non-Hilar Obstruction

Abstract

The authors analyzed the follow-up data of 58 patients with malignant obstructive jaundice who underwent percutaneous palliative treatment with Wallstents over a 4-year period. Thirty-nine patients had obstruction at the hilar level, and 19 patients had common bile duct obstruction without hilar involvement. Stent patency and survival were calculated with the Kaplan-Meier method. Early complications occurred in 14 patients (24%) and were managed conservatively. There were two procedure-related deaths (3.4%) due to sepsis and pancreatitis, and the overall 30-day mortality was 14%. Forty-eight patients have died, nine patients are surviving (average, 11 months), and one patient was lost to follow-up. Forty-four patients (77%) experienced relief of their initial symptoms, with bilirubin levels returning to normal in 63%. The 12-month patency rate of the endoprostheses was 46% in patients with hilar obstruction and 89% in patients with non-hilar obstruction (P = .029). Late biliary complications were documented in 20 patients (35%). Thirteen patients with hilar obstruction and two patients with common duct obstruction required at least one reintervention; stent patency was restored in all patients but one. The overall 6-month survival rate was 50%, and the 12-month survival rate, 36%; no significant difference was found between patients with hilar and non-hilar obstruction. The long-term patency of the Wallstent endoprosthesis was excellent if common duct obstruction was treated but was significantly lower in the presence of hilar involvement. Use of the Wallstent did not result in a lower complication rate compared with the reported results of plastic endoprostheses. Reinterventions to restore stent patency were successful in almost all cases. The survival of patients with hilar and with non-hilar obstruction was similar.