THERAPY FOR BILIARY STENOSES AND OCCLUSIONS WITH USE OF 3 DIFFERENT METALLIC STENTS - SINGLE-CENTER EXPERIENCE

PURPOSE: The authors report their experience with three different meta llic stents for the treatment of biliary obstructions during a 6.5-yea r period (between February 1989 and June 1995), MATERIALS AND METHODS: In an uncontrolled, nonrandomized, and prospective study, 168 patient s with obstructive jaundice underwent transhepatic placement of metall ic stents. Patients were excluded if they were deemed too ill for inte rvention or had incorrectable coagulopathy, Those patients undergoing external and/or intraluminal radiation therapy, and patients in whom a n internal-external catheter was kept in place after insertion of a st ent were not included. Inoperable malignant disease was diagnosed in 1 57 patients (93.5%). Eleven patients presented with a benign biliary s tricture that could not be managed by means of angioplasty. One hundre d fifty-five Wallstents were placed in 122 patients, 65 tantalum Strec ker stents were placed in 30 patients, and 18 Memotherm stents were pl aced in 16 patients, The patients were followed until September 1996 o r until death. RESULTS: Regarding malignant obstruction, the 30-day mo rtality rate was 10.7% without any procedure-related death, and overal l survival rates after 100 and 200 days were 63% and 22%, respectively , Regarding benign stricture, eight of 11 patients were alive after a median follow-up of 50.6 months without any 30-day mortality, Major co mplications occurred in 16 patients (10.2%) who had malignancy, and in two patients (18.2%) with benign biliary disease, The cumulative pate ncy rate in malignant obstructions was significantly higher for the Wa llstent than for the Memotherm stent (P < .05) and nonsignificantly hi gher for the Wallstent than for the tantalum Strecker stent (P >.05), Reintervention due to recurrent obstructive jaundice was necessary in 28 patients (17.8%) with malignancy, and in six patients (54.5%) with benign stricture. CONCLUSIONS: The Wallstent is the most effective in achieving long-term palliation in patients with malignant obstructive jaundice, The treatment of benign biliary strictures with metallic ste nts is associated with a low long-term patency rate.