INITIAL EXPERIENCE WITH A NEW, PARTIALLY COVERED WALLSTENT FOR MALIGNANT BILIARY OBSTRUCTION

Background and Study Aims: Metal biliary stents have been shown to be superior to plastic stents with regard to patency and the risk of disl ocation, However, tumor ingrowth through the mesh continues to be a si gnificant problem, We report here on our preliminary experience with c overed metal stents. Patients ann Methods: Ten patients (mean age 68 y ears) with malignant biliary obstruction, who were not considered to b e surgical candidates, received a partially covered Wallstent. The pat ients were followed up prospectively for one year, including laborator y tests, abdominal ultrasound, and plain abdominal radiographs during the first three months, and by monthly telephone interview thereafter. Results: Stent insertion was technically successful in all patients, and led to a reduction in bilirubin levels from 8.4 mg/dl to 0.7 mg/dl . The mean survival of the patients was 7.5 months after the diagnosis of malignancy, and six months after stent insertion; only two patient s were still alive after 12 months, During the observation period, fou r patients suffered from stent dysfunction for periods of one to nine months. These dysfunctions included thr ee stent occlusions, which wer e successfully treated by inserting plastic stents, and one dislocatio n, which was treated by endoscopic replacement of the stent, There app eared to be a correlation between the narrowest stent diameter immedia tely after release and stent dysfunction. Conclusion: Covering biliary metal stents is a potential solution to prevent tissue ingrowth, Howe ver, current prototypes need to be improved in order to achieve this g oal.