BILIARY WALLSTENT ENDOPROSTHESIS IN MALIGNANT HILAR OBSTRUCTION - LONG-TERM RESULTS WITH REGARD TO THE TYPE OF OBSTRUCTION

Aim: To evaluate the clinical efficacy of percutaneously placed biliar y Wallstents in the management of malignant hilar obstruction with reg ard to the obstruction type. Patients and methods: Sixty-six Wallstent s were inserted in 41 patients with inoperable hilar obstruction: 13 p atients had a type I obstruction according to Bismuth-classification, 18 a type II, eight a type III, and two a type IV obstruction, respect ively, Clinical follow-up data were obtained from all the patients and the referring physicians. Results: Stent placement was technically su ccessfully in all patients, The procedure-related death rate was 2% (o ne patient), but the overall 30-day mortality rate was 39%, mostly due to advanced malignant disease, cardiac failure or pneumonia. Stent oc clusion was found in 11 patients (27%) after 87 days (mean; range, 8-1 90 days), After stent placement, the mean stent patency was 96 days an d the mean survival was 131 days with no significant difference betwee n patients with obstruction type I, II and III. Multivariate analysis revealed that patients with obstruction due to gallbladder carcinoma h ad a significantly shorter survival than patients with cholangio-carci noma or hilar obstruction due to metastases. Conclusion: Overall, the insertion of Wallstent endoprostheses offers moderate results for pall iation of hilar biliary obstruction regardless of the type of obstruct ion, In patients with cholangiocarcinoma, long-term results are good e ven fdr complicated strictures (type III), In patients with hilar obst ruction due to gallbladder carcinoma the outcome is generally poor, re gardless of the type of obstruction.