OPTIMAL TIMING FOR STENT REPLACEMENT IN MALIGNANT BILIARY-TRACT OBSTRUCTION

Endoscopic stent placement has become accepted palliative therapy for malignant biliary tract obstruction. Because stent occlusion remains a significant late complication, prophylactic replacement has been sugg ested, although the appropriate time interval remains unclear. Patient s with malignant biliary strictures who received 10F or 11.5F stents w ere analyzed with respect to clinical response, occlusion rates at 3 a nd 6 months, and survival rates. Seventy stents were placed in 50 pati ents. Pancreatic carcinoma was the most common underlying malignancy. Overall, obstructive symptoms resolved in 94% of cases. Occlusion rate s at 3 months (4.2%) and 6 months (10.8%) were not significantly diffe rent. Median overall survival averaged 22 weeks. Results were also str atified by underlying diagnosis, with the worst clinical response and survival being seen in the group of patients with metastatic cancer. F indings suggest that the time interval for stent replacement can be ex tended safely from 3 to 6 months, resulting in decreased patient disco mfort and cost and obviating any replacement in that significant perce ntage of patients who expire before 6 months.