Percutaneous transhepatic insertion of self-expanding short metal stents for biliary obstruction before resection of pancreatic or duodenal malignancy proves to be safe and effective.
BACKGROUND
The British Society of Gastroenterology guidelines for the management of malignant obstructive jaundice state: "If a stent is placed prior to surgery, this should be of the plastic type and it should be placed endoscopically. Self-expanding metal stents should not be inserted in patients who are likely to proceed to resection." In 2003, a small series of complications after endoscopic intervention caused a change in the authors' practice. Currently, all patients requiring relief of biliary obstruction before surgical resection undergo attempted insertion of a short metal biliary stent.


METHODS
Retrospective analysis of the authors' prospective database containing all patients presenting with periampullary and pancreatic tumors between January 2004 and May 2008 was performed.


RESULTS
The authors have attempted percutaneous placement of internal metal stents in 67 patients with resectable malignancies and biliary obstruction. Stenting was successful for 53 patients (79%), and 5 patients (9.4%) experienced complications. These five patients were successfully managed conservatively, and all proceeded to trial dissection. The mean bilirubin level was 253 mg/dl before intervention and 33 mg/dl before surgery for the stented patients compared with 308 mg/dl before intervention and 102 mg/dl before surgery for those who needed external drainage.


CONCLUSIONS
Percutaneous insertion of short metal stents provides a safe and effective alternative to endoscopic stent placement for treating jaundice preoperatively in patients with potentially resectable tumors around the pancreatic head.
Briggs
Christopher D
CD
Department of Hepatobiliary and Pancreatic Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK. chrisbriggs@doctors.org.uk
Irving
Glen R B
GR
Cresswell
Andrew
A
Peck
Robert
R
Lee
Fred
F
Peterson
Mark
M
Cameron
Iain C
IC
D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D016009:Chi-Square Distribution; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications / Q000601:surgery; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D008670:Metals; D001663:Bilirubin