title: Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors.
abstract: OBJECTIVE
  To compare the efficacy of self-expandable metallic stents (EMS) in the treatment of distal and proximal stricture of malignant biliary tumors.
  
  
  METHODS
  From March 1995 to June 2004, 61 patients (40 males, 21 females) with malignant biliary obstruction who received self-expandable metallic stent implantation were reviewed retrospectively. The stents were inserted by an endoscopic or percutaneous transhepatic method. We tried to place two stents in the biliary system in T or Y configuration in cases of hilar tumors with bilateral hepatic duct obstruction. The end points of the study were stent occlusion or patient death.
  
  
  RESULTS
  The mean time of stent patency was 421 +/- 67 d in the group of proximal stricture (group I) and 168 +/- 18 d in the group of distal stricture (group II). The difference was significant in borderline between the two groups (P = 0.0567). The mean survival time was 574 +/- 76 d in group I and 182 +/- 25 d in group II. There was a significant difference between the two groups (P = 0.0005).
  
  
  CONCLUSIONS
  EMS implantation is a feasible, palliative method for unresectable malignant biliary obstruction. The clinical efficacy of EMS in patients with proximal hilar tumors is better than that in patients with distal tumors.
authors.affiliation: Department of Gastroenterology, Shin-Kong Wu-Ho-Su Memorial Hospital, 95 Weng Chang Road, Shih-Lin District, Taipei, Taiwan,China. m000723@ms.skh.org.tw
authors.forename: Jui-Hao
authors.initials: JH
authors.lastname: Chen
authors.forename: Cheuk-Kay
authors.initials: CK
authors.lastname: Sun
authors.forename: Chao-Sheng
authors.initials: CS
authors.lastname: Liao
authors.forename: Chain-Smoke
authors.initials: CS
authors.lastname: Chua
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002779:Cholestasis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care; D015607:Stents / Q000009:adverse effects