Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Abstract

Background/Aims:Metal stent insertion is a common palliative treatment for distal malignant biliary obstruction (MBO) but whether placement across the sphincter of Oddi (SO) causes more complications or shorter survival is in question. The aim of this study was to compare the clinical outcomes of percutaneous uncovered self-expandable metal stent placement above and across the SO in patients with distal MBO.Patients and Methods:We retrospectively studied 59 patients who underwent uncovered metal stent placement for distal MBO between January 2012 and March 2016. Stents were placed above the SO for 22 subjects (group A) and across the SO for 37 subjects (group B). Early cholangitis, stent occlusion, and overall survival time were compared between the two groups.Results:Clinical success was 90.9 and 86.5% for groups A and B, respectively. Early cholangitis occurred in 2 patients (9.1%) in group A and in 6 patients (16.2%) in group B (P = 0.645). Median stent patency and median survival time was 105 and 140 days for group A, 120 and 160 days for group B, respectively. The stent occlusion (31.8% in group A and 21.6% in group B, P = 0.454) and the cumulative stent patency times (P = 0.886) did not differ between the two groups. There was no significant difference in cumulative patient survival between the two groups (P = 0.810).Conclusion:Uncovered metal stent placement across the SO did not significantly affect early cholangitis, stent patency, or patient survival.

Survival benefit of percutaneous transhepatic biliary drainage for malignant biliary tract obstruction—a prospective study comparing external and internal drainage techniques

“…It is assumed that the stent or catheter passing through the ampulla would result in pancreatitis and cholangitis; however, both complications were few in our series and not directly related to ID or ED. Recent studies also have supported our finding [27]. 4 patients had acute pancreatitis in our series; however, none were clinically significant, and all resolved with medical management.…”

Management of distal malignant biliary obstruction

“…In their study, Zhang et al . [ 13 ] demonstrated efficacy between the suprapapillary and transpapillary placement of USEMS in the management of distal MBO. Retrospectively, they studied 59 patients who underwent USEMS placement for distal MBO between January 2012 and March 2016.…”