Percutaneous metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma.
OBJECTIVE
To evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma (HCC).


METHODS
Fifteen men (mean age, 59.3 years) with obstructive jaundice resulting from HCC were treated with self-expandable metallic stents (28 stents in 19 sessions). The authors evaluated the technical success, clinical success (decrease of 30% of total serum bilirubin level or <2 mg/dL [34.2 micromol/L]), treatment efficacy according to lowest total serum bilirubin level, complications, and duration of stent patency.


RESULTS
Technical success was achieved in all patients. Clinical success was achieved in 11 of the 15 patients (73%). After stent placement, seven patients (47%) had a low bilirubin level (<2 mg/dL [34.2 micromol/L]), three (20%) had an intermediate bilirubin level (2-10 mg/dL [34.2-171 micromol/L]), and five (33%) had a high bilirubin level (>10 mg/dL [171 micromol/L]). A low bilirubin level was achieved in all patients with Child-Pugh A disease and stage T2 or T3 HCC. Major complications such as hemobilia necessitating transfusion (n=1) or abscess formation (n=1) occurred in two of the 19 sessions (10%). The overall mean stent patency was 149.8 days (range, 12-790 days). The mean stent patency in patients with Child-Pugh class A disease (257.8 days) was significantly longer than that of patients with Child-Pugh class B and C disease (123.2 and 63 days, respectively) (P<.05).


CONCLUSIONS
The percutaneous placement of a self-expandable metallic stent is a feasible and effective palliative treatment for patients with obstructive jaundice resulting from HCC, especially for those with Child-Pugh class A disease and stage T2 or T3 HCC.
Hong
Hyun Pyo
HP
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-ku, Seoul, 110-746 Korea.
Kim
Seung Kwon
SK
Seo
Tae-Seok
TS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D002404:Catheterization; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000497:Alloys; C013616:nitinol; D007459:Iodized Oil; D004317:Doxorubicin