title: Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of percutaneously placed biliary Wallstents in the management of malignant hilar obstruction with regard to the obstruction type.
  
  
  METHODS
  Sixty-six Wallstents were inserted in 41 patients with inoperable hilar obstruction: 13 patients had a type I obstruction according to Bismuth-classification, 18 a type II, eight a type III, and two a type IV obstruction, respectively. Clinical follow-up data were obtained from all the patients and the referring physicians.
  
  
  RESULTS
  Stent placement was technically successfully in all patients. The procedure-related death rate was 2% (one patient), but the overall 30-day mortality rate was 39%, mostly due to advanced malignant disease, cardiac failure or pneumonia. Stent occlusion was found in 11 patients (27%) after 87 days (mean; range, 8-190 days). After stent placement, the mean stent patency was 96 days and the mean survival was 131 days with no significant difference between patients with obstruction type I, II and III. Multivariate analysis revealed that patients with obstruction due to gallbladder carcinoma had a significantly shorter survival than patients with cholangio-carcinoma or hilar obstruction due to metastases.
  
  
  CONCLUSIONS
  Overall, the insertion of Wallstent endoprostheses offers moderate results for palliation of hilar biliary obstruction regardless of the type of obstruction. In patients with cholangiocarcinoma, long-term results are good even for complicated strictures (type III). In patients with hilar obstruction due to gallbladder carcinoma the outcome is generally poor, regardless of the type of obstruction.
authors.affiliation: Department of Radiology, University of Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Schima
authors.forename: R
authors.initials: R
authors.lastname: Prokesch
authors.forename: C
authors.initials: C
authors.lastname: Osterreicher
authors.forename: S
authors.initials: S
authors.lastname: Thurnher
authors.forename: R
authors.initials: R
authors.lastname: Függer
authors.forename: R
authors.initials: R
authors.lastname: Schöfl
authors.forename: L
authors.initials: L
authors.lastname: Havelec
authors.forename: J
authors.initials: J
authors.lastname: Lammer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000150:complications*; D018281:Cholangiocarcinoma / Q000150:complications; D002758:Cholangiography; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015607:Stents; D015996:Survival Rate