Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents.
OBJECTIVE
To compare the clinical efficacy and treatment costs of plastic versus metal biliary stents.


METHODS
In a randomized trial, 101 patients with malignant common bile duct obstruction underwent transhepatic stent implantation and were followed up until death. Patients were stratified into risk and nonrisk groups. Forty-nine patients received 12-F plastic stents, and 52 received expandable metal stents. Plastic endoprostheses were placed in a two-step procedure; metal stent, in a single procedure. Kaplan-Meier analyses were used to compare patient survival and stent patency rates.


RESULTS
The 30-day mortality rate was significantly lower for metal stents (five of 52 [10%]) than plastic stents (12 of 49 [24%]; P = .05). The obstruction rate was 19% (10 of 52; median patency, 272 days) for metal stents and 27% for plastic stents (13 of 49; median patency, 96 days; P < .01). Median time until death or obstruction was longer for metal stents (122 vs 81 days; P < .01). Placement of metal stents was associated with shorter hospital stay (10 vs 21 days; P < .01) and lower cost ($7,542 vs $12,129; P < .01).


CONCLUSIONS
Use of self-expanding metal stents appears to show substantial benefits for patients and to be cost-effective.
Lammer
J
J
Department of Angiography and Interventional Radiology, University of Vienna, Austria.
Hausegger
K A
KA
Flückiger
F
F
Winkelbauer
F W
FW
Wildling
R
R
Klein
G E
GE
Thurnher
S A
SA
Havelec
L
L
D000368:Aged; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004067:Digestive System Neoplasms / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D010969:Plastics; D011446:Prospective Studies; D012307:Risk Factors; D013193:Stainless Steel; D015607:Stents / Q000191:economics; D015996:Survival Rate; D013997:Time Factors
D010969:Plastics; D013193:Stainless Steel