title: Results of percutaneous plastic stents for malignant distal biliary obstruction following failed endoscopic stent insertion and comparison with current literature on expandable metallic stents.
abstract: BACKGROUND
  Endoscopic stenting is an effective method of relieving biliary obstruction in patients with unresectable malignancy. If this fails, optimal management is controversial. Percutaneous insertion of plastic or mesh metal stents has been advocated.
  
  
  OBJECTIVE
  To review the outcome of percutaneous plastic stents and compare this with contemporary data from the literature on mesh metal stenting.
  
  
  METHODS
  Over a period of six years, 400 patients had attempted endoscopic stenting for distal malignant biliary obstruction which failed in 54 (13.5%). These 54 patients were treated with percutaneously placed plastic stents.
  
  
  RESULTS
  Percutaneous stenting was technically successful in 48 patients (89%). Early complications occurred in 13 patients (24%), the commonest being acute cholangitis in seven (12%). There was no procedure-related mortality but a 30-day mortality of 11 % (n = 6). Ten patients (18%) required re-admission after 30 days for stent block (mean period 4 months). Forty-seven patients (87%) were followed up until death. The median survival for the patients undergoing palliative stenting was 3 months (5 days to 17 months).
  
  
  CONCLUSIONS
  These results suggest that percutaneous plastic stents can be used safely and effectively in patients who have failed endoscopic stenting.
authors.affiliation: Department of Surgery, Royal Free Hospital and Medical School, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Doctor
authors.forename: R
authors.initials: R
authors.lastname: Dick
authors.forename: R
authors.initials: R
authors.lastname: Rai
authors.forename: N
authors.initials: N
authors.lastname: Dafnios
authors.forename: A
authors.initials: A
authors.lastname: Salamat
authors.forename: H
authors.initials: H
authors.lastname: Whiteway
authors.forename: J
authors.initials: J
authors.lastname: Dooley
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome