title: Failed metallic biliary stents: causes and management of delayed complications.
abstract: OBJECTIVE
  To describe the incidence, management and long-term outcome of metal stent failure in patients with malignant biliary obstruction.
  
  
  METHODS
  Sixty-nine patients received a total of 93 metallic biliary stents for relief of malignant biliary obstruction. Twenty-nine patients had hilar tumours; 40 had common bile duct tumours.
  
  
  RESULTS
  Ten of 69 patients (14%) presented with stent occlusion at a mean interval of 4 months after stent insertion. Five of 29 patients (17%) with hilar lesions and five of 40 patients (12%) with common bile duct lesions had stent occlusion. Occlusion was due to tumour overgrowth in eight patients and to occlusion by debris in two. The eight patients with tumour overgrowth were treated with internal/external catheters (5 patients), no therapy (2 patients), and further metal stents (1 patient). These eight patients with tumour overgrowth had a limited lifespan after tumour overgrowth occurred with a mean survival of 2.6 months. The two patients with occlusion due to debris were treated by sweeping the stent with a balloon catheter and these patients survived 26 and 27 months, respectively.
  
  
  CONCLUSIONS
  Adequate peripheral purchase in the biliary tree and overstenting are necessary to prevent tumour overgrowth when stenting hilar lesions. The development of stent occlusion due to tumour overgrowth heralds a limited survival and internal/external catheters are preferred over further metal stents for palliation.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
authors.forename: S L
authors.initials: SL
authors.lastname: Dawson
authors.forename: P R
authors.initials: PR
authors.lastname: Mueller
authors.forename: P F
authors.initials: PF
authors.lastname: Hahn
authors.forename: S
authors.initials: S
authors.lastname: Saini
authors.forename: D S
authors.initials: DS
authors.lastname: Lu
authors.forename: M A
authors.initials: MA
authors.lastname: Goldberg
authors.forename: G S
authors.initials: GS
authors.lastname: Gazelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D001652:Bile Ducts / Q000601:surgery*; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000601:surgery; D002780:Cholestasis, Intrahepatic / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents; D017211:Treatment Failure
chemical_list: D008670:Metals