The treatment of bile duct stenoses using metal mesh endoprostheses (stents)]

Transhepatic biliary drainage is an established therapy for the palliative treatment of biliary stenosis. Long-term biliary drainage may be accomplished by the introduction of an endoprosthesis. Plastic endoprostheses are, however, prone to clogging and dislocation. A new type of endoprosthesis consisting of an expandable metallic mesh has, therefore, been developed. Results in 51 patients using two different types of metallic stents demonstrated that the technical success rate is higher with self-expanding stents than with balloon-expandable stents. Symptoms of obstructive jaundice were effectively palliated in the vast majority of patients (80%). Reobstruction during the first 4 weeks occurred in only 1 patient. Malfunction was related to the inappropriate length of the stent. At follow-up, 25% of patients with malignant biliary strictures developed recurrent jaundice, which was controlled by a single additional placement of a stent or a plastic endoprosthesis. In conclusion, although recurrent biliary stenosis is still a problem, the frequency of reinterventions can be considerably reduced by the use of metallic instead of plastic endoprostheses (20% vs. 45%).