title: Percutaneous placement of self-expandable metallic biliary stents in malignant extrahepatic strictures: indications of transpapillary and suprapapillary methods.
abstract: OBJECTIVE
  To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied.
  
  
  METHODS
  Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n = 16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared.
  
  
  RESULTS
  Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p <0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62).
  
  
  CONCLUSIONS
  For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.
authors.affiliation: Department of Radiology, Yong-dong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. stent@medikorea.net
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.forename: J S
authors.initials: JS
authors.lastname: Yu
authors.forename: J C
authors.initials: JC
authors.lastname: Hwang
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications; D002758:Cholangiography; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D004067:Digestive System Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D015642:Radiology, Interventional; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed