title: Choice of plastic or metal stent for patients with jaundice with pancreaticobiliary malignancy using simple clinical tools: a prospective evaluation.
abstract: OBJECTIVE
  Although plastic stents have been recommended for patients with pancreaticobiliary malignancy and an expected survival of less than 6 months, no study has developed criteria to assess survival which could then determine the choice of stent for biliary decompression. The aim of the study was to determine the utility of simple clinical tools in deciding whether to place a plastic or metal stent in patients with malignant obstructive jaundice.
  
  
  METHODS
  At presentation for endoscopic retrograde cholangiopancreatography for suspected malignant distal bile duct obstruction, prospectively patients with Karnofsky score of <80 and/or metastatic disease to the liver underwent placement of 10-French plastic stents while patients with a Karnofsky score of ≥80 underwent placement of self-expandable metal stents (SEMS). Long-term stent patency and mortality was determined.
  
  
  RESULTS
  98 patients (mean age 66.5 years; 62.2% male) were enrolled with 67 (68.4%) receiving plastic stents and 31 (31.6%) uncovered SEMS. Overall, patients receiving plastic stents had a median survival of 2.8 months compared with 11.6 months for metallic stents (p<0.0001). Patients with a Karnofsky score <80 or liver metastases had very poor survival of 3.1 and 1.8 months, respectively. The overall reintervention rate was 42% for those receiving plastic stents and 19% for metallic stents.
  
  
  CONCLUSIONS
  The decision whether to place a plastic stent or SEMS for patients with distal malignant obstructive jaundice may be based on simple clinical tools resulting in low rates of reintervention.
authors.affiliation: Division of Gastroenterology and Hepatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
authors.forename: C Mel
authors.identifier: 0000-0001-5246-3419
authors.initials: CM
authors.lastname: Wilcox
authors.affiliation: Division of Gastroenterology and Hepatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
authors.forename: Hwasoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
authors.forename: Toni
authors.initials: T
authors.lastname: Seay
authors.affiliation: Division of Gastroenterology and Hepatology , University of Alabama at Birmingham , Birmingham, Alabama , USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
keywords: ADENOCARCINOMA; BILIARY ENDOSCOPY; BILIARY STRICTURES