WALLSTENTS VERSUS PLASTIC STENTS IN MALIGNANT BILIARY OBSTRUCTION - EFFECTS OF STENT PATENCY OF THE FIRST AND 2ND STENT ON PATIENT COMPLIANCE AND SURVIVAL

Objectives: In prospective trials in patients with malignant biliary o bstruction, it has been reported that Wallstents prolong stent patency , but this does not translate into a significant survival benefit. Com pared with prospective trials, however, survival may be different in c linical practice because of differences in patient compliance. We repo rt on a retrospective, long term analysis comparing Wallstents versus plastic stents. Methods: Plastic endoprostheses (70 patients) and endo scopic Wallstents (95 patients) were placed in 165 consecutive patient s with irresectable, malignant biliary obstruction in a first (1990-91 ) and second (1992-93) time period. Stent occlusion was treated by pla stic stent placement. Results: Patient characteristics were quite comp arable in both stent groups. Initial placement of a Wallstent resulted in an increase of median stent patency of the first (10 vs 4 months, p < 0.001) and second (8 vs 3 months, p < 0.05) stent, a decrease of a dditional endoscopic procedures (20 vs 58%, p < 0.005), an increase of patient compliance reflected by a decrease of patients dying with unt reated stent conclusion (9 vs 30%, p < 0.001), and an increase of surv ival time (6.5 vs 4 months, p < 0.05). Conclusions: Initial placement of a Wallstent results in an increase of stent patency of the first an d second stent. Duration of stent patency appears to have a determinan t effect on patient compliance. Increased stent patency and patient co mpliance seem to improve survival in clinical practice.