Expandable metal biliary stenting in patients with recurrent premature polyethylene stent occlusion

OBJECTIVES: Expandable metal stents are currently used to treat biliary tra ct obstruction. Few data exist on the role of metal stents in patients with recurrent premature plastic biliary stent occlusion. We report our prelimi nary results using an expandable metal biliary stent with enhanced stent fl exibility in this group of patients. Our aim was to assess the efficacy of the Diamond biliary stent in the treatment of recurrent premature biliary p lastic stent blockage. METHODS: From September 1997 to June 1998, six patients with inoperable bil iary obstruction and at least one prior episode of plastic stent occlusion were treated with an expandable metal biliary prosthesis. There were four w omen and six men, with a mean age of 73 +/- 11 yr. Five patients had malign ant biliary obstruction, and one inoperable patient had a biliary stricture secondary to chronic pancreatitis. Patients were followed-up prospectively until either stent occlusion or death. The patency duration of the metal s tents was compared to that of the most recently placed plastic stents. RESULTS: All stents were successfully inserted endoscopically with visualiz ed biliary drainage. No significant immediate postprocedural complications were noted. Median time from initial diagnosis of biliary obstruction to me tal stent insertion was 35 wk (range 7-142), during which time patients had occluded a median of 4.5 plastic stents (range 2-5). Median patient surviv al was 117 days (15-312) and median time to blockage of the last plastic st ent was 25.5 days (range 10-90 days). Three cases of metal stent occlusion occurred. One patient had early stent occlusion at 9 days because of debris and sludge clogging the metal stent. Two other patients developed stent oc clusion at 120 and 157 days. Two stents remained patent until the patients' deaths at 15 and 87 days. Overall median stent patency was 139 days. The t hree patients who developed stent occlusion were treated with successful in sertion of one or more plastic stents through the existing metal stent. Dur ation of metal stent patency was significantly longer than that of the last plastic stent (58.8 days longer; 95% CI [6.4, Ill];p = 0.03). CONCLUSIONS: Metal biliary prostheses represent an effective management str ategy for recurrent plastic biliary stent obstruction. Patients in this sub group may have a shorter duration of metal stent patency than the reported duration of stent patency in patients receiving initial metal stent placeme nt. However the duration of patency still seems to be significantly longer than that of the most recently placed plastic stent. (C) 2001 by Am. Cell. of Gastroenterology.