Treatment of malignant biliary obstruction using one metallic stent per patient

Hippokratia 2005, 9(3):119-123

N Vougiouklis, E Chartabilas, I Agorastos, E Akriviadis, G Chatzitheocharis, N Evgenidis, I Goulis, I Kountouras, N Mavroudis, G Mparaoutoglou, D Mpintoudis, N Nikolaidis, C Papanikolaou
Radiology Dpr, Hippokratio General Hospital, Thessaloniki, Greece


Background: Drainage of malignant jaundice by percutaneously inserted stents is an established method in inoperab!e neoplasms. In a group of consecutive patients with malignant biliary obstruction, an attempt was made to drain the bile using only one metallic stent (MS) per patient. This study examines the results of this approach.
Patients and methods: In 23 men and 18 women (mean age 61.6 years) with obstructive jaundice caused by inoperable neoplasm, 43 shape-memory metallic stents (SMMS) were percutaneously inserted.
Results: In one case, two SMMS were used for the drainage of the two segmenta! ducts of the right hepatic lobe. In the remaining 40 patients, the stents were successfully released in the proper position in 38 patients and in an incorrect position in 2 patients. Their final length after their adjustment to the bile duct was increased by 20-30% resulting in protrusion of 8 MS into the duodenum. The serum bilirubin level before the intervention was 9 to 40 (mean 19.6) mg/dl while the lowest value after the drainage was 2 to 15 (mean 4.3) mg/dl. Serious complications were observed in 14,6 % of patients whilst the 30-day mortality was 5%. Seven patients underwent reintervention because of significant aggravation of jaundice.
Conclusion: Treatment of malignant biliary obstruction with the use of only one SMMS of considerable size is feasible and effective; the main drawback is the inability to accurately estimate the final position of the distal end of the stent.