Long-Term Experience in Wallstent Therapy for Malignant Choledochal Stenosis

Abstract

During a four-year period up to May 1993, 118 patients (mean age 69 years) with malignant bile duct stenoses were treated with a total of 127 selfexpanding 10-mm metal endoprostheses (Wallstent), most of them endoscopically (n = 102). Technical problems during and shortly after implantation occurred in five cases (4.2%), but could all be solved endoscopically. Serum bilirubin decreased from a mean of 8.0 mg/dl at presentation to a mean of 2.0 mg/dl after stenting. Nineteen patients died within the first three months (5% within the first 30 days); recurrent obstruction, as manifested by recurrent jaundice or cholangitis, or both, was encountered in 14%. Fifty-one patients who survived longer were followed up until death or for a minimum of 12 months (mean follow-up: 12 months). Stent patency rates in this group were 86% (six months), 72% (12 months) and 64% (18 months), survival for these time periods being 63%, 35% and 17%, respectively. No significant stent-related complications were noted; stent occlusion occurred in 12% of patients after a mean of 168 days, and was successfully managed endoscopically (thermal cleaning, implantation of further stents) in all cases. We conclude from our long-term follow-up data that patients surviving longer than three months are the ones most likely to benefit from Wallstent insertion for malignant jaundice.

Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction

“…The development of self-expanding metal stents has offered another option for palliation of gastrointestinal stenosis. These have been used in malignant biliary obstruction with a good clinical outcome [6,7,14,19,20,25,29,36,50]. At the same time, self-expanding metal stents have been used for the palliation of gastric outlet and duodenal obstruction with good results [8, 11, 12, 41-44, 47, 54, 57].…”

A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction

“…Various studies showed that metallic stents have longer patency and lower occlusion rates compared with conventional plastic stents. [6][7][8][9][10] However, tumours often invade the EMS via the mesh of the metallic wire, resulting in their obstruction. To protect against tumour ingrowth, EMS covered with a non-porous membrane were developed in the 1990s.…”

Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

“…Distant metastases (mainly in the liver) [19, 72], size of primary tumor [72], laboratory findings [17, 59, 64, 86], pain [59] or a combination of those factors [79]. Some malignancies causing hilar obstruction have [58, 62, 63] or have not [57, 65] been found to be associated with a significantly poorer prognosis. Thus, endoscopic palliation of MDO compared to MHO has [58, 62, 63] or has not [57, 65] been found to significantly prolong survival.…”

“…Some malignancies causing hilar obstruction have [58, 62, 63] or have not [57, 65] been found to be associated with a significantly poorer prognosis. Thus, endoscopic palliation of MDO compared to MHO has [58, 62, 63] or has not [57, 65] been found to significantly prolong survival. Similarly, age at diagnosis has [16] or has not [65] been found to predict survival.…”

“…Thus, endoscopic palliation of MDO compared to MHO has [58, 62, 63] or has not [57, 65] been found to significantly prolong survival. Similarly, age at diagnosis has [16] or has not [65] been found to predict survival. Female gender [64] and low score at ASA classification [19] have been reported to be associated with longer survival.…”