[Endoscopic palliation of inoperable hilar biliary carcinoma with self-expanding metal stents].
OBJECTIVE
Prosthetic palliation of patients with malignant hilar stenoses shows particular difficulties, especially in advanced lesions. This is a prospective report of the efficacy of endoscopically inserted single metal stent for complex malignant biliary hilar obstruction.


METHODS
Sixty-one consecutive patients were recruited. Contrast injection was deliberately limited to the distal end of the malignant tumor stenosis. A single metal stent was inserted across the stricture into the duct that was technically easiest for the drainage.


RESULTS
Successful stent insertion was achieved in 59 of 61 (96.7%) patients. In 3 (4.9%) cases stent malfunction occurred. Successful drainage was achieved in 59 (96.7%) patients and complete resolution of jaundice was achieved in 86% of cases. Early complications included 3 (4.9%) cases of cholangitis and 2 (3.2%) cases of stent occlusion. Late occlusion of the stent occurred in 14 patients (22.9%), including 10 (16.3%) cases of cholangitis and 1 case of liver abscess. Median stent patency was 169 days. Median patient survival was 140 days.


CONCLUSIONS
Metal stent insertion is safe, feasible, and achieves adequate drainage in the great majority of patients with non-resectable hilar cholangiocarcinoma.
De Palma
G D
GD
Settore di Diagnostica e Terapia Endoscopica, Dipartimento di Chirurgia Generale, Oncologica e Tecnologie Avanzate, Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, Naples. gdepalma@arrotino.it
Rega
M
M
Persico
M
M
Mastantuomo
L
L
Patrone
F
F
Di Marino
M
M
Persico
G
G
D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D015607:Stents