Palliation of hilar biliary obstruction front colorectal metastases by endoscopic stent insertion

Background: In patients with hepatic metastases from colorectal carcinoma t here is a distinct subgroup in whom jaundice is not due to hepatic replacem ent but rather biliary obstruction. We reviewed our experience with stent i nsertion in patients with malignant proximal biliary obstruction from metas tatic colorectal carcinoma. Methods: Thirty-three patients were treated between July 1992 and December 1996. Placement of a single stent was attempted at initial endoscopic retro grade cholangiopancreatography. Hilar biliary obstruction was classified ac cording to Bismuth's classification. Results: Successful stent placement was possible in 94% overall and at init ial endoscopic retrograde cholangiopancreatography in 39% of patients. Succ essful stent placement occurred significantly more often in patients with a type I stricture. Cholangitis was the principal complication occurring in 24% of patients. The 30-day mortality rate was 24%, with death occurring si gnificantly less often in patients with a type I or II stricture. Overall, 45% of patients had a 30% fall in bilirubin at 1 week. The median survival was 81 days, with significantly longer survival seen in patients with a typ e I or II stricture. Conclusions: Endoscopic stent placement offers effective palliation in most patients with hilar obstruction from colorectal metastases. A subset of pa tients with type III strictures and greater than 3 intrahepatic metastases often do not benefit from stent insertion.