title: Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival.
abstract: OBJECTIVE
  In prospective trials in patients with malignant biliary obstruction, it has been reported that Wallstents prolong stent patency, but this does not translate into a significant survival benefit. Compared with prospective trials, however, survival may be different in clinical practice because of differences in patient compliance. We report on a retrospective, long term analysis comparing Wallstents versus plastic stents.
  
  
  METHODS
  Plastic endoprostheses (70 patients) and endoscopic Wallstents (95 patients) were placed in 165 consecutive patients with irresectable, malignant biliary obstruction in a first (1990-91) and second (1992-93) time period. Stent occlusion was treated by plastic stent placement.
  
  
  RESULTS
  Patient characteristics were quite comparable in both stent groups. Initial placement of a Wallstent resulted in an increase of median stent patency of the first (10 vs 4 months, p < 0.001) and second (8 vs 3 months, p < 0.05) stent, a decrease of additional endoscopic procedures (20 vs 58%, p < 0.005), an increase of patient compliance reflected by a decrease of patients dying with untreated stent occlusion (9 vs 30%, p < 0.001), and an increase of survival time (6.5 vs 4 months, p < 0.05).
  
  
  CONCLUSIONS
  Initial placement of a Wallstent results in an increase of stent patency of the first and second stent. Duration of stent patency appears to have a determinant effect on patient compliance. Increased stent patency and patient compliance seem to improve survival in clinical practice.
authors.affiliation: Gastrointestinal Unit, Inselspital, University Hospital, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Schmassmann
authors.forename: E
authors.initials: E
authors.lastname: von Gunten
authors.forename: J
authors.initials: J
authors.lastname: Knuchel
authors.forename: U
authors.initials: U
authors.lastname: Scheurer
authors.forename: H F
authors.initials: HF
authors.lastname: Fehr
authors.forename: F
authors.initials: F
authors.lastname: Halter
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D016022:Case-Control Studies; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications; D010349:Patient Compliance; D010969:Plastics; D012189:Retrospective Studies; D013193:Stainless Steel; D015607:Stents / Q000191:economics; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D010969:Plastics; D013193:Stainless Steel