title: Palliation of hilar biliary obstruction from colorectal metastases by endoscopic stent insertion.
abstract: BACKGROUND
  In patients with hepatic metastases from colorectal carcinoma there is a distinct subgroup in whom jaundice is not due to hepatic replacement but rather biliary obstruction. We reviewed our experience with stent insertion in patients with malignant proximal biliary obstruction from metastatic colorectal carcinoma.
  
  
  METHODS
  Thirty-three patients were treated between July 1992 and December 1996. Placement of a single stent was attempted at initial endoscopic retrograde cholangiopancreatography. Hilar biliary obstruction was classified according to Bismuth's classification.
  
  
  RESULTS
  Successful stent placement was possible in 94% overall and at initial endoscopic retrograde cholangiopancreatography in 39% of patients. Successful stent placement occurred significantly more often in patients with a type I stricture. Cholangitis was the principal complication occurring in 24% of patients. The 30-day mortality rate was 24%, with death occurring significantly less often in patients with a type I or II stricture. Overall, 45% of patients had a 30% fall in bilirubin at 1 week. The median survival was 81 days, with significantly longer survival seen in patients with a type I or II stricture.
  
  
  CONCLUSIONS
  Endoscopic stent placement offers effective palliation in most patients with hilar obstruction from colorectal metastases. A subset of patients with type III strictures and greater than 3 intrahepatic metastases often do not benefit from stent insertion.
authors.affiliation: Departments of Gastroenterology and Surgery, St. George and Westmead Hospitals, Sydney, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Valiozis
authors.forename: A
authors.initials: A
authors.lastname: Zekry
authors.forename: S J
authors.initials: SJ
authors.lastname: Williams
authors.forename: D R
authors.initials: DR
authors.lastname: Hunt
authors.forename: M J
authors.initials: MJ
authors.lastname: Bourke
authors.forename: J O
authors.initials: JO
authors.lastname: Jorgensen
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
authors.forename: P I
authors.initials: PI
authors.lastname: Craig
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome