Duodenal stenosis after endoscopic biliary metallic stent placement for malignant biliary stenosis.
BACKGROUND
Some patients who undergo endoscopic insertion of biliary metallic stents for malignant biliary stenosis later develop symptomatic duodenal stenosis due to tumor invasion.


METHODS
We compared the development of symptomatic duodenal stenosis in patients who had undergone endoscopic biliary metallic stent insertion (metallic stent group) with that in patients who had undergone either endoscopic biliary drainage or percutaneous transhepatic biliary drainage with a plastic stent (nonmetallic stent group). Fourteen patients in the metallic stent group were matched with 14 patients in a nonmetallic stent group. All patients had a Karnofsky performance status score of greater than 90% and were clinical stage IV when they underwent biliary decompression.


RESULTS
Although there was no difference in survival time between the 2 groups, 5 of 14 patients in the metallic stent group developed symptomatic duodenal stenosis due to tumor invasion during the observation period whereas this occurred in only 1 of 14 patients in the nonmetallic stent group. Multiple logistic regression analysis indicates that the type of stent (p = 0.022) and survival time (p = 0.002) are 2 independent prognostic factors for the development of symptomatic duodenal stenosis.


CONCLUSIONS
Patients treated with endoscopic biliary metallic stent insertion are prone to develop symptomatic duodenal stenosis due to tumor invasion compared with those treated with either endoscopic retrograde biliary drainage or percutaneous transhepatic biliary drainage with a plastic stent.
Hyodo
T
T
Division of Gastroenterology and Department of General Medicine I, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Yoshida
Y
Y
Yamanaka
T
T
Imawari
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000628:therapy*; D004380:Duodenal Obstruction / Q000453:epidemiology / Q000209:etiology*; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate
D008670:Metals