title: Percutaneous biliary metal wall stenting in malignant obstructive jaundice.
abstract: BACKGROUND
  Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive.
  
  
  METHODS
  A review of case notes of patients who had Wallstents inserted percutaneously from January 1996 to December 2000.
  
  
  RESULTS
  Eighty-nine patients with a median age of 72 years underwent percutaneous insertion of biliary metal stents. The diagnoses were cholangiocarcinoma (41.5%), pancreatic carcinoma (40.5%), nodal metastases at the porta hepatis (14.6%) and gall bladder cancer (3.4%). Ninety-six per cent of patients improved their hyperbilirubinaemia to normal levels by 1 month. The median post-procedure hospital stay was 16 days. Early overall complications (within 30 days of stenting) occurred in 30% of patients (70% of these were disease related). The 30 day mortality rate was 20% (n = 18). Fifty (70%) patients were readmitted to hospital, most commonly because of carcinomatosis (16) or stent obstruction (12). The symptom-free period ranged from 2 weeks to 13 months. Median survival for all patients was 3.5 months. Survival correlated inversely with serum bilirubin at presentation (r = -0.34, P = 0.001), but not with other liver function tests.
  
  
  CONCLUSIONS
  Metal wall stenting for malignant obstructive jaundice provides good palliation with low, procedure-related morbidity and mortality, but poor overall survival from disease-related morbidity. Survival significantly correlates with pre-stenting serum bilirubin levels. There is a need to identify the subgroup of patients in whom stenting has no beneficial effect.
authors.affiliation: Section of Surgery, University Hospital Nottingham NHS Trust, Nottingham, UK.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Indar
authors.forename: Dileep N
authors.initials: DN
authors.lastname: Lobo
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Gilliam
authors.forename: Roger
authors.initials: R
authors.lastname: Gregson
authors.forename: Ian
authors.initials: I
authors.lastname: Davidson
authors.forename: Simon
authors.initials: S
authors.lastname: Whittaker
authors.forename: John
authors.initials: J
authors.lastname: Doran
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Rowlands
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Beckingham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004067:Digestive System Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D015607:Stents; D016896:Treatment Outcome