Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents.

BACKGROUND The aim of this study was to evaluate the efficacy of an endoscopically inserted self-expandable metal stent for treatment of biliary obstruction caused by nonresectable hilar cholangiocarcinoma. METHODS Data on all patients with nonresectable hilar cholangiocarcinoma receiving self-expandable metal stents between January 1990 and April 2000 were retrospectively reviewed. Patients with pseudo Klatskin tumors (metastases in the liver hilum) and gallbladder carcinoma were excluded. Early complications (within 30 days of stent placement), early and late stent occlusion, stent patency, and biliary reintervention rates were recorded. RESULTS Fifty-two Wallstents were inserted in 36 patients, with 7, 13, and 16 having, respectively, Bismuth type I/II, III, and IV lesions. Insertion was successful in 35 of 36 (97%) patients. Complications occurred within the first 30 days after insertion in 5 patients (14%) but did not require biliary reintervention. Thirty-day mortality was 6% (2 deaths). There were 3 early (9%) and 8 late (23%) stent occlusions, bringing the total to 11 patients (31%) who required biliary reintervention after Wallstent insertion. Median Wallstent patency and patient survival were, respectively, 169 days (95% CI [154, 184]) and 147 days (95% CI [106, 188]), with no difference between patients with Bismuth I/II, III, IV type tumors. CONCLUSIONS Wallstent insertion is safe and feasible, and achieves successful palliation without the need for further biliary reintervention in the majority (69%) of patients with nonresectable hilar cholangiocarcinoma.

[1]  K. Huibregtse.  The wallstent for malignant biliary obstruction. , 1999, Gastrointestinal Endoscopy Clinics of North America.

[2]  M. Catalano,et al.  "Tannenbaum" teflon stents vs traditional polyethylene stents for treatment of malignant biliary strictures: A multicenter, prospective randomized trial , 1998 .

[3]  J. Bergman,et al.  A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. , 1998, Endoscopy.

[4]  A. Cull,et al.  Quality of life in patients stented for malignant biliary obstructions , 1997, European journal of gastroenterology & hepatology.

[5]  P. Kortan,et al.  Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. , 1996, Gastrointestinal endoscopy.

[6]  S. Ghosh,et al.  Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid. , 1994, Gut.

[7]  E. Alstead,et al.  Symptom relief and quality of life after stenting for malignant bile duct obstruction. , 1994, Gut.

[8]  J. Pausch,et al.  A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. , 1993, Endoscopy.

[9]  K. Klose,et al.  Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. , 1993, Endoscopy.

[10]  G. Tytgat,et al.  Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction , 1992, The Lancet.

[11]  St. M. Sc.,et al.  The current management of hilar cholangiocarcinoma. , 1992, Advances in surgery.

[12]  S. Kadakia,et al.  Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. , 1992, Gastrointestinal endoscopy.

[13]  P. Cotton,et al.  Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. , 1991, Gut.

[14]  G. Tytgat,et al.  Clogging of biliary endoprostheses: a new perspective. , 1990, Gut.

[15]  J. Leung,et al.  Clogging of Biliary Stents: Mechanisms and Possible Solutions , 1990 .

[16]  P. Fockens,et al.  Endoscopic Placement of Expandable Metal Stents for Biliary Strictures - A Preliminary Report on Experience with 33 Patients , 1989, Endoscopy.

[17]  P. Cotton,et al.  A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. , 1989, Endoscopy.

[18]  J. van Marle,et al.  A placebo-controlled study on the efficacy of aspirin and doxycycline in preventing clogging of biliary endoprostheses. , 1989, Gastrointestinal endoscopy.

[19]  M. Classen,et al.  Self-expanding Biliary Stents: Preliminary Clinical Experience , 1989, Endoscopy.

[20]  P. Cotton,et al.  Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. , 1988, Gastrointestinal endoscopy.

[21]  J. Devière,et al.  Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. , 1988, Gastrointestinal endoscopy.

[22]  S. Williams,et al.  The management of high-grade hilar strictures by endoscopic insertion of self-expanding metal endoprostheses. , 1997, Endoscopy.