February 1995

Endoscopic Stenting for Malignant Biliary Obstruction

Author Affiliations

From the Department of Surgery, The University of Hong Kong, Queen Mary Hospital.

Arch Surg. 1995;130(2):204-207. doi:10.1001/archsurg.1995.01430020094018

Objective:  To evaluate the results of endoscopic stenting in patients with malignant biliary obstruction.

Design:  Retrospective review.

Setting:  Surgical endoscopy unit at a tertiary referral center.

Patients and Intervention:  Plastic endoprosthetic stents were inserted for the relief of biliary obstruction in 131 consecutive patients. Among the 104 patients with malignant biliary obstruction, 60 underwent stenting as definitive palliative treatment.

Main Outcome Measures:  Data on the type and size of stents employed, their effectiveness in relieving jaundice, their complications, and the quality of survival were analyzed.

Results:  Median survival was 1.93 months. The majority of the stents (88.3%) were placed endoscopically, and single straight stents were most frequently used (96.7%). Jaundice was relieved in 35 patients. Early (≤14 days) and late acute cholangitis were found in four and 11 patients, respectively. Early and late stent migration was noticed in two and six patients, respectively. Pancreatitis occurred in one patient, and no papillotomy site bleeding was encountered. When compared with the 18 patients with proximal obstruction at or above the common hepatic duct, the 42 patients with distal ductal obstruction had longer median survival (P=.03) and more effective relief of jaundice (P=.005) and required less antibiotic treatment (P=.03). These 42 patients also enjoyed better quality of survival when it was analyzed with reference to six objective parameters (P=.0018).

Conclusions:  Stenting offers palliation of malignant biliary obstruction, and the results are particularly encouraging in distal obstruction.(Arch Surg. 1995;130:204-207)