Management of malignant biliary stricture with self-expanding metallic stent |
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Authors: | G C Vitale G M Larson M George C Tatum |
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Institution: | (1) Department of Surgery, University of Louisville, Louisville, KY 40292, USA, US;(2) Department of Radiology, Norton Hospital, Louisville, KY 40202, USA, US |
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Abstract: | Background: Self-expanding metallic mesh stents are designed to remain patent longer than polyethylene (PE) stents, which generally clog
in 3 to 4 months. Though more expensive, metal stents may therefore be a better choice for malignant strictures.
Methods: From January 1991 to October 1995, we performed ERCP in 212 patients with malignant or benign strictures, and 34 ultimately
had insertion of a metallic stent. These stents were placed by the percutaneous transhepatic route in 17 patients and endoscopically
in 17.
Results: Metallic stent insertion was successful in each case and relieved the preoperative jaundice and cholangitis. There were no
procedure-related deaths; complications were pancreatitis (one) and hemorrhage (one). Overall stent patency was 6.2 months.
Three of 34 stents occluded due to tumor ingrowth at 3, 4.5, and 8 months and were treated by placing a new PE stent through
the blocked metal stent. The remaining 31 stents remained patent until patient death (n= 15, mean survival = 4.9 months) or are still open (n= 16, mean patency = 12.2 months).
Conclusions: Self-expanding metal stents provide effective palliation of malignant biliary strictures and should be considered an alternative
to open surgery. Metal stents remain patent much longer than PE stents and usually a single session of metal stenting can
palliate biliary obstruction for life.
Received: 20 March 1996/Accepted: 9 May 1996 |
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Keywords: | : Biliary stricture — ERCP — Metallic stents — Wallstents |
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