Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival.
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.
Schmassmann
A
A
Gastrointestinal Unit, Inselspital, University Hospital, Bern, Switzerland.
von Gunten
E
E
Knuchel
J
J
Scheurer
U
U
Fehr
H F
HF
Halter
F
F
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
D010969:Plastics; D013193:Stainless Steel