title: Percutaneous metallic stent placement in patients with cancer recurrence at bilioenterostomy site.
abstract: OBJECTIVE
  To investigate the outcomes of percutaneous metallic stent placement in patients with malignant bilioenterostomy obstruction and to assess the risk factors influencing stent patency.
  
  
  METHODS
  From August 2008 to January 2012, 53 patients with malignant bilioenterostomy obstructions were treated with percutaneous placement of biliary metallic stents; this included expanded polytetrafluoroethylene (ePTFE)-covered stent placement in 36 patients and uncovered stent placement in 17 patients.
  
  
  RESULTS
  A total of 75 stents were successfully placed in 53 patients. No major complications occurred in any patients, and minor complications occurred in nine patients (17%). The mean serum bilirubin level, which was 3.6 mg/dL ± 0.7 before drainage, decreased significantly to 2.5 mg/dL ± 0.4 at 1 month after stent placement (P = .041). Successful internal drainage was achieved in 44 of the 53 patients (83%). Kaplan-Meier analysis showed a median overall survival time of 145 days (95% confidence interval, 100-190 d), a median stent patency time of 313 days (95% confidence interval, 46-580 d), and cumulative stent patency rates at 1, 3, 6, 9, and 12 months of 91%, 75%, 64%, 56%, and 45%, respectively. Multivariate Cox regression analysis showed that the use of uncovered stents (odds ratio, 2.924; P = .033) was the only significant independent factor associated with stent occlusion.
  
  
  CONCLUSIONS
  Percutaneous metallic stent placement is a safe and effective method for the treatment of patients with malignant bilioenterostomy obstruction. Moreover, as uncovered stent placement is the only significant independent factor associated with stent occlusion, ePTFE-covered stent placement is preferable in these patients.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Cherry
authors.initials: C
authors.lastname: Kim
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Heung Kyu
authors.initials: HK
authors.lastname: Ko
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000401:mortality* / Q000601:surgery*; D004766:Enterostomy / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019919:Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D011859:Radiography; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: OR; PTBD; ePTFE; expanded polytetrafluoroethylene; odds ratio; percutaneous transhepatic biliary drainage