FAILED METALLIC BILIARY STENTS - CAUSES AND MANAGEMENT OF DELAYED COMPLICATIONS

Objective: To describe the incidence, management and long-term outcome of metal stent failure in patients with malignant biliary obstruction . Subjects and Methods: Sixty-nine patients received a total of 93 met allic biliary stents for relief of malignant biliary obstruction. Twen ty-nine patients had hilar tumours; 40 had common bile duct tumours. R esults: Ten of 69 patients (14%) presented with stent occlusion at a m ean interval of 4 months after stent insertion. Five of 29 patients (1 7%) with hilar lesions and five of 40 patients (12%) with common bile duct lesions had stent occlusion. Occlusion was due to tumour overgrow th in eight patients and to occlusion by debris in two. The eight pati ents with tumour overgrowth were treated with internal/external cathet ers (5 patients), no therapy (2 patients), and further metal stents (1 patient). These eight patients with tumour overgrowth had a limited l ifespan after tumour overgrowth occurred with a mean survival of 2.6 m onths. The two patients with occlusion due to debris were treated by s weeping the stent with a balloon catheter and these patients survived 26 and 27 months, respectively. Conclusion: Adequate peripheral purcha se in the biliary tree and overstenting are necessary to prevent tumou r overgrowth when stenting hilar lesions. The development of stent occ lusion due to tumour overgrowth heralds a limited survival and interna l/external catheters are preferred over further metal stents for palli ation.