title: Management of biliary neoplastic obstruction with two different metallic stents implanted in one session.
abstract: The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
authors.forename: S
authors.initials: S
authors.lastname: Fabiano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pipitone
authors.forename: Alessio
authors.initials: A
authors.lastname: Spinelli
authors.forename: Carlo Andrea
authors.initials: CA
authors.lastname: Reale
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colangelo
authors.forename: Enrico
authors.initials: E
authors.lastname: Pampana
authors.forename: Andrea
authors.initials: A
authors.lastname: Romagnoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome