Outcomes of metallic biliary stent insertion in patients with malignant bilobar obstruction

Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction

Objective

To investigate the outcomes of percutaneous metallic stent placements in patients with malignant biliary hilar obstruction (MBHO).

Materials and Methods

From January 2007 to December 2014, 415 patients (mean age, 65 years; 261 men [62.8%]) with MBHO were retrospectively studied. All the patients underwent unilateral or bilateral stenting in a T, Y, or crisscross configuration utilizing covered or uncovered stents. The clinical outcomes evaluated were technical and clinical success, complications, overall survival rates, and stent occlusion-free survival.

Results

A total of 784 stents were successfully placed in 415 patients. Fifty-five patients had complications. These complications included hemobilia (n = 19), cholangitis (n = 13), cholecystitis (n = 11), bilomas (n = 10), peritonitis (n = 1), and hepatic vein-biliary fistula (n = 1). Clinical success was achieved in 370 patients (89.1%). Ninety-seven patients were lost to follow-up. Stent dysfunction due to tumor ingrowth (n = 107), sludge incrustation (n = 44), and other causes (n = 3) occurred in 154 of 318 patients. The median overall survival and the stent occlusion-free survival were 212 days (95% confidence interval [CI], 186-237 days) and 141 days (95% CI, 126-156 days), respectively. The stent type and its configuration did not affect technical success, complications, successful internal drainage, overall survival, or stent occlusion-free survival.

Conclusion

Percutaneous stent placement may be safe and effective for internal drainage in patients with MBHO. Furthermore, stent type and configuration may not significantly affect clinical outcomes.

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

PURPOSE

To evaluate prognostic factors for stent patency and survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent percutaneous biliary stent placement.

MATERIALS AND METHODS

This prospective study followed 92 consecutive patients with pCCA who underwent metal stent placement between January 2013 and July 2014. Of the total number of patients, 11 had ascites, and 36 had biliary obstruction for > 1 month at the time of stent placement. Cumulative patency and survival rates were assessed with Kaplan-Meier curves, and independent predictors were calculated with Cox regression. A new formula was developed to predict patient survival.

RESULTS

Tumor size was significantly associated with stent patency (hazard ratio = 2.425; 95% confidence interval, 1.134-5.168). Independent predictors of survival included lymph node metastasis, intrahepatic mass lesion, cancer antigen 19-9 (CA19-9), ascites, and duration of jaundice. A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction-0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9-0 if < 500, 1 if > 500) + 7 × (ascites-0 if none present, 1 if ascites present) + 10 × (lymph node metastasis-0 if no metastasis, 1 if metastasis present) + 9 (intrahepatic mass lesion-0 if absent, 1 if present). Among patients who developed stent occlusion, patients who underwent recanalization of the occluded stent had longer survival compared with patients who did not undergo recanalization (109 d vs 29 d, P = .001).

CONCLUSIONS

Prognostic factors for survival after percutaneous stent placement in patients with pCCA were tumor stage, duration of jaundice, CA19-9, and ascites. Tumor size affected stent patency. Prognosis for patients with reintervention after occlusion of the stent improved.

Efficacy of percutaneous transhepatic biliary drainage in treatment of high malignant biliary obstruction

AIM: To investigate the therapeutic effect of percutaneous transhepatic biliary drainage and biliary stent placement in patients with malignant hilar biliary obstruction to provide a basis for clinical selection of appropriate treatments.

METHODS: Clinical data for 76 patients with malignant hilar biliary obstructive jaundice treated at the Fourth Hospital of Hebei Medical University were analyzed retrospectively. Forty-two patients were men and 34 were women. Their age ranged from 42 to 76 years, with a mean value of 64.2 years. The majority of patients (42/69) had hilar bile duct carcinoma or postoperative recurrence. Other primary diseases included gallbladder carcinoma (n = 13), liver cancer (n = 6), hepatic metastasis of pancreatic, gastric and cardiac cancer (n = 14). Based on the Bismuth-Corlette classification, we divided the cases into five types: I (n = 16), II (n = 23), IIIa (n = 19), IIIb (n = 3) and IV (n = 15). All patients had complete clinical data, stable diseases and no absolute contraindications on intervention. Renal and liver function was examined in all patients to estimate the decreasing range of total bilirubin, which can be an index of short-term curative effect. The differences in total bilirubin change and survival between the unilateral and bilateral drainage groups were also compared.

RESULTS: Total bilirubin decreased significantly after treatment (338.52 mmol/L ± 93.21 mmol/L vs 128.13 mmol/L ± 52.17 mmol/L, P < 0.05). The decrease in total bilirubin showed no significant difference between the unilateral drainage group and the bilateral drainage group (99.19 mmol/L ± 53.81 mmol/L vs 104.62 mmol/L ± 63.12 mmol/L, P > 0.05). There was also no significant difference in survival rate between the unilateral drainage group and bilateral drainage group.

CONCLUSION: For high obstructive jaundice, multi-channel drainage is preferred. For patients with Bismuth III-IV disease, biliary drainage can also achieve satisfactory therapeutic effect. Biliary drainage and stent placement are safe and effective methods for relieving biliary obstruction, reducing bilirubin and lengthening the survival time.