Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction

Abstract

ObjectiveTo investigate the outcomes of percutaneous metallic stent placements in patients with malignant biliary hilar obstruction (MBHO).Materials and MethodsFrom January 2007 to December 2014, 415 patients (mean age, 65 years; 261 men [62.8%]) with MBHO were retrospectively studied. All the patients underwent unilateral or bilateral stenting in a T, Y, or crisscross configuration utilizing covered or uncovered stents. The clinical outcomes evaluated were technical and clinical success, complications, overall survival rates, and stent occlusion-free survival.ResultsA total of 784 stents were successfully placed in 415 patients. Fifty-five patients had complications. These complications included hemobilia (n = 19), cholangitis (n = 13), cholecystitis (n = 11), bilomas (n = 10), peritonitis (n = 1), and hepatic vein-biliary fistula (n = 1). Clinical success was achieved in 370 patients (89.1%). Ninety-seven patients were lost to follow-up. Stent dysfunction due to tumor ingrowth (n = 107), sludge incrustation (n = 44), and other causes (n = 3) occurred in 154 of 318 patients. The median overall survival and the stent occlusion-free survival were 212 days (95% confidence interval [CI], 186−237 days) and 141 days (95% CI, 126−156 days), respectively. The stent type and its configuration did not affect technical success, complications, successful internal drainage, overall survival, or stent occlusion-free survival.ConclusionPercutaneous stent placement may be safe and effective for internal drainage in patients with MBHO. Furthermore, stent type and configuration may not significantly affect clinical outcomes.

A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction

“…PHC, DCC, and PC are typically present with biliary obstruction, which often increases the risk of perioperative mortality and morbidity [21, 22]. Palliative biliary drainage has been repeatedly confirmed to be efficient in the improvement of prognosis for patients with unresectable MBO [23, 24], but it still remains controversial whether patients with resectable MBO would be benefited from PBD [2–4]. Furthermore, whether either PTBD or EBD is better is another puzzle [5–9], although both have been conducted prevalently worldwide.…”

Preoperative Biliary Drainage: Methods, Advantages, and Complications

“…The occlusion of the stent may be due to tumor growth, excessive tumor growth, or mud. Recurrent cholangitis due to stent occlusion is observed in approximately 30% of cases, which requires repeat stenting [1,13,24].…”

“…Malignant obstructive jaundice is a common condition caused by various adenocarcinomas, including cholangiocarcinoma [1][2][3][4][5][6][7]. Hilar cholangiocarcinoma, which is also known as Klatskin's tumor, accounts for about 50% of cholangiocarcinoma cases [3,8].…”

“…Due to the silent tumor growth, curative resection is often not suitable at diagnosis. Only 10-20% of cases will be candidates for curative resection [1,2].…”

Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma

“…Percutaneous biliary stent implantation is considered a preferred solution for relieving high malignant biliary obstruction and achieving intrahepatic drainage. However, simple biliary stent placement may result in blockage due to tumor invasion or overgrowth, bile accumulation, or biofilm formation[15-18]. Extending the effective drainage time of the stent or drainage tube is of great significance for improving the quality of life of patients and the prognosis of patients.…”