Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

Abstract

The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82 (65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients' survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective.

Percutaneous management of malignant biliary disease: factors that influence ability to overcome the stricture.

“…There are detailed guidelines and many reports on the techniques, indications, complications and management of malignant biliary obstructions. However, to our knowledge, the factors that may affect the ability of a malignant biliary obstruction to be crossed have not been discussed in detail in the existing literature (1)(2)(3)(4)(5)(6)(7)(8). In the studies of Neal et al (9) and Dowsett et al (10), the ability of biliary strictures to be traversed was found to be unrelated to stricture type or location.…”

“…In patients with a high-level obstruction and in patients with low-level obstruction for whom endoscopic intervention is not suitable, the percutaneous transhepatic approach is the palliative treatment of choice. Indications, technical procedures, related complications, and success rates of percutaneous intervention have been discussed in detail in previous studies (1)(2)(3)(4)(5)(6)(7)(8).…”

Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction: A retrospective clinical analysis

“…Currently, both protocols are utilized side by side at many institutions as patient-related factors, which may determine the complication rate and outcome, are not well defined. [8]…”

Complex videoendoscopic, radiological diagnosis and miniinvasive treatment of obstructive jaundice

“…В на-стоящее время лишь небольшое количество паци-ентов с опухолями панкреатодуоденальной зоны могут быть оперированы радикально, большин-ству же возможно выполнить лишь паллиативное лечение [20][21][22], при этом в большинстве случаев используются обходные анастомозы или стентиро-вание, в том числе в сочетании с химио-, радио-, фотодинамической терапией, химиоэмболизацией [23][24][25][26][27][28][29].…”