Palliative endoscopic stent drainage of non-operable malignant biliary obstruction

Endoscopic stenting is the treatment of choice for inoperable malignant biliary obstruction. The standard plastic stents in use, however, tend to clog with time. We report the patient survival and stent patency rates in two separate groups of patients treated endoscopically for malignant biliary strictures on the basis of a retrospective review of patient medical records. The first group of 27 patients was treated with small caliber polyethylene stents in 1997. The second group of ten selected patients with fairly good life expectancy was treated with self-expandable wallstents due to early plastic stent occlusion in 1998. The median stent patency and patient survival of patients treated with plastic stents was 11 and 14 weeks, respectively. Early stent occlusion occurred in seven patients. The median stent patency and patient survival of the patients treated with wallstents were 25 and 32 weeks, respectively. Late stent occlusion due to tumour ingrowth occurred in two patients. The last generation of self-expandable wallstent is endoscopically easy to insert and represents a valuable supplement to standard plastic stenting. Due to high cost, however, metal stents should preferably be offered patients with early plastic stent occlusion and estimated good life expectancy.