EXPANDABLE METALLIC BILIARY STENTS

Eighteen expandable metallic biliary stents were inserted in patients with malignant (16 patients) or benign (two patients) biliary strictur es. Four were the Gianturco-Rosch biliary Z-stents and the remaining 1 4 were the Wallstent. The stents were delivered through either the end oscopic transpapillary (10 patients), percutaneous transhepatic (five patients) or combined percutaneous-endoscopic (three patients) route. No failure in implantation was encountered. Bile drainage was successf ul in all patients. Stent occlusions were observed in four patients wi th hilar obstruction due to tumour overgrowth above the stents at 30-6 7 days (mean 47.75 days) after insertion. The occlusions were drained percutaneously (two patients) or endoscopically (two patients). Migrat ion of stent did not occur. After a median follow-up period of 170.5 d ays (range 57-731 days), 11 patients were still alive and free of jaun dice. The median patency period of the stents for common bile duct and hilar obstruction was 288.5 days (range 117-731 days) and 61.5 days ( range 30-188 days), respectively. The overall median patency period wa s 165 days. It is concluded that expandable metallic biliary stent is a useful adjunct to the treatment of malignant biliary obstructions wi th a better result in distal obstruction.