Self-Expanding Metallic Stents in Malignant Biliary Obstruction-Patency and Clinical Efficacy: A Prospective Study from North India Tertiary Center

 

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ABSTRACT

Background and Aims: Endoscopic insertion of self-expandable metallic stent (SEMS) is now accepted as first line modality of treatment for palliation in unresectable extra-hepatic biliary obstructive jaundice. This study was done to assess the clinical efficacy and duration of patency of endoscopically inserted metallic stent in un-resectable malignant biliary obstruction. Materials and Methods: Between 2015 to 2017, 101 patients who underwent ERCP and SEMS placement for palliation of malignant biliary obstruction were included prospectively. Main outcome measures were technical success, clinical success, mean duration of SEMS patency, clinical efficacy, rate of biliary re-intervention and survival of patients. Results: Overall technical success and clinical success was achieved in 93% and 82.2% respectively. Mean duration of SEMS patency was 109 days. Analysis in subgroup of patients classified according to site of obstruction (Hilar -68, Distal CBD-33) showed that median duration of stent patency was significantly better in distal biliary stricture (135 days vs 95 days), whereas re-intervention rates were higher in higher biliary stricture than distal stricture (41% Vs 6%). Seven patients with hilar biliary stricture suffered post-SEMS insertion cholangitis. Conclusion: SEMS placement is feasible palliative method for un-resectable malignant biliary obstruction with acceptable technical and clinical success. The duration of SEMS patency and clinical efficacy is significantly better in distal biliary stricture whereas re-intervention rate is higher in hilar biliary stricture.

• REFERENCES

• 1 Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet 1994; 344: 1655-60
  CrossrefPubMedGoogle Scholar
• 2 Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut 1994; 35: 467-70
  CrossrefPubMedGoogle Scholar
• 3 Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: A prospective trial examining impact on quality of life. Gastrointest Endosc 2002; 56: 835-41
  CrossrefPubMedGoogle Scholar
• 4 Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB. Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 1999; 49: 466-71
  CrossrefPubMedGoogle Scholar
• 5 Raju RP, Jaganmohan SR, Ross WA, Davila ML, Javle M, Raju GS. et al. Optimum palliation of inoperable hilar cholangiocarcinoma: Comparative assessment of the efficacy of plastic and self-expanding metal stents. Dig Dis Sci 2011; 56: 1557-64
  CrossrefPubMedGoogle Scholar
• 6 Rerknimitr R, Kladcharoen N, Mahachai V, Kullavanijaya P. Result of endoscopic biliary drainage in hilar cholangiocarcinoma. J Clin Gastroenterol 2004; 38: 518-23
  CrossrefPubMedGoogle Scholar
• 7 Saluja SS, Gulati M, Garg PK, Pal H, Pal S, Sahni P. et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: A randomized trial and quality of life assessment. Clin Gastroenterol Hepatol 2008; 6: 944-50.e3
  CrossrefPubMedGoogle Scholar
• 8 Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340: 1488-92
  CrossrefPubMedGoogle Scholar
• 9 Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993; 25: 207-12
  Article in Thieme ConnectPubMedGoogle Scholar
• 10 Rieber A, Brambs HJ. Metallic stents in malignant biliary obstruction. Cardiovasc Intervent Radiol 1997; 20: 43-9
  CrossrefPubMedGoogle Scholar
• 11 Arguedas MR, Heudebert GH, Stinnett AA, Wilcox CM. Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: A cost-effectiveness analysis. Am J Gastroenterol 2002; 97: 898-904
  CrossrefPubMedGoogle Scholar
• 12 Schöfl R, Brownstone E, Reichel W, Fortunat W, Doblhofer F, Samec HJ. et al. Malignant bile-duct obstruction: Experience with self-expanding metal endoprostheses (Wallstents) in Austria. Endoscopy 1994; 26: 592-69
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 O’Brien S, Hatfield AR, Craig PI, Williams SP. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut 1995; 36: 618-21
  CrossrefPubMedGoogle Scholar
• 14 Ferlitsch A, Oesterreicher C, Dumonceau JM, Deviere J, Leban T, Born P. et al. Diamond stents for palliation of malignant bile duct obstruction: A prospective multicenter evaluation. Endoscopy 2001; 33: 645-50
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 Brountzos EN, Petropoulos E, Kelekis NL, Magoulas D, Alexopoulou E, Kagianni E. et al. Malignant biliary obstruction: Management with percutaneous metallic stent placement. Hepatogastroenterology 1999; 46: 2764-71
  PubMedGoogle Scholar
• 16 Chen JH, Sun CK, Liao CS, Chua CS. Self-expandable metallic stents for malignant biliary obstruction: Efficacy on proximal and distal tumors. World J Gastroenterol 2006; 12: 119-22
  CrossrefPubMedGoogle Scholar
• 17 Aadam AA, Evans DB, Khan A, Oh Y, Dua K. Efficacy and safety of self-expandable metal stents for biliary decompression in patients receiving neoadjuvant therapy for pancreatic cancer: A prospective study. Gastrointest Endosc 2012; 76: 67-75
  CrossrefPubMedGoogle Scholar
• 18 Lofts FJ, Evans TR, Mansi JL, Glees JP, Knight MJ. Bile duct stents: Is there an increased rate of complications in patients receiving chemotherapy. Eur J Cancer 1997; 33: 209-13
  CrossrefPubMedGoogle Scholar