Outcomes in percutaneous stenting of non-hepato-biliary/pancreatic malignant jaundice

Abstract

The aim of this study is to review the practice and outcomes at our institution of percutaneous transhepatic placement of metallic biliary stents for non-hepato-biliary/pancreatic (non-HBP) malignant obstructive jaundice. A retrospective review was performed of the records of all patients undergoing transhepatic stenting for non-HBP malignant obstructive jaundice over a 7-year period. A total of 25 patients were successfully stented and linear regression analysis of a variety of demographic, clinical and laboratory markers against survival was performed. Survival after stenting varied from 1 to 1354 days (median 58, mean 152). An initial bilirubin level less than 300 micromol/L (P=0.01) and a reduction of greater than 50% in bilirubin post stenting (P=0.02) were strong predictors of improved survival. Older patients survived longer than younger ones (P<0.01). There was a weak association of survival with an albumin>30 g/L (P=0.06), but no statistically significant correlation with creatinine or haemoglobin levels or active tumour treatment after stenting. There were few major complications from the procedures. Transhepatic metallic biliary stenting for non-HBP malignant biliary obstruction is a safe and effective procedure, and with careful patient selection, significant periods of survival and palliation of jaundice can be achieved.

Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

“…The overarching aims of biliary drainage in malignancy are palliation of symptoms, improvement in quality of life, prevention of complications like sepsis, and to improve chances of delivering palliative chemotherapy based on performance status and available treatments. 8 , 9 There is plenty of evidence available to support this procedure for palliation of symptoms 3 in different patient groups, but there is little evidence to suggest long-term outcomes after stenting, or predictive factors that may identify patients more likely to benefit for better selection. An ability by the treating clinician to positively delineate patient subgroups in order to select those deemed suitable for what is an invasive procedure will be beneficial for patients and for the sustenance of strained health care resources.…”

Ictericia obstructiva de causa maligna irresecable tras CPRE fallida: factores predictores del pronóstico: Tratamiento mediante drenaje guiado por ecoendoscopia versus drenaje percutáneo

“…En este grupo la supervivencia fue de 4 meses (24).Recientemente, en 2014, Afshar et al objetivó una supervivencia de 143 días en un estudio publicado donde se analizaron los factores predictores de supervivencia tras la inserción de prótesis biliares en patología maligna inoperable(25).Existen diversos estudios en los que se analizan diferentes variables a partir de las cuales se determina la supervivencia tras el drenaje biliar: tamaño del tumor(114), variables analíticas(115), complicaciones relacionadas con el procedimiento y éxito clínico de este(116). A continuación se detallan los resultados de algunos de los más recientes:Meller et at(117) publicaron en 2010 un análisis de 25 pacientes con ictericia obstructiva tumoral que fueron sometidos a CTPH y estudiaron los factores predictores de supervivencia. Concluyeron que los factores determinantes de mejoría en la supervivencia fueron: bilirrubina inicial menor de 300 µmol/l (p=0.01), reducción de más del 50% de esta tras la inserción de la prótesis (p=0.02) y los pacientes de más edad con respecto a los más jóvenes.Abali et al (35) publicaron en 2013 un estudio en el que analizaron de manera retrospectiva los factores pronósticos que derivaron en una mayor supervivencia en 140 pacientes con ictericia obstructiva que fueron sometidos a CTPH.…”