Management of malignant biliary stricture with self-expanding metallic stent.
BACKGROUND
Self-expanding metallic mesh stents are designed to remain patent longer than polyethylene (PE) stents, which generally clog in 3 to 4 months. Though more expensive, metal stents may therefore be a better choice for malignant strictures.


METHODS
From January 1991 to October 1995, we performed ERCP in 212 patients with malignant or benign strictures, and 34 ultimately had insertion of a metallic stent. These stents were placed by the percutaneous transhepatic route in 17 patients and endoscopically in 17.


RESULTS
Metallic stent insertion was successful in each case and relieved the preoperative jaundice and cholangitis. There were no procedure-related deaths; complications were pancreatitis (one) and hemorrhage (one). Overall stent patency was 6.2 months. Three of 34 stents occluded due to tumor ingrowth at 3, 4.5, and 8 months and were treated by placing a new PE stent through the blocked metal stent. The remaining 31 stents remained patent until patient death (n = 15, mean survival = 4.9 months) or are still open (n = 16, mean patency = 12.2 months).


CONCLUSIONS
Self-expanding metal stents provide effective palliation of malignant biliary strictures and should be considered an alternative to open surgery. Metal stents remain patent much longer than PE stents and usually a single session of metal stenting can palliate biliary obstruction for life.
Vitale
G C
GC
Department of Surgery, University of Louisville, Louisville, KY 40292, USA.
Larson
G M
GM
George
M
M
Tatum
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents