Published online Sep 15, 1996. doi: 10.3748/wjg.v2.i3.149
Revised: July 10, 1996
Accepted: August 12, 1996
Published online: September 15, 1996
AIM: To report the first experience in China in the treatment of malignant biliary obstruction with expandable metal stent, which allows the insertion of an endoprosthesis as large as 1 cm in diameter.
METHODS: Between April 1994 and May 1996, we implanted expandable metal stents in 57 patients with incurable malignant biliary obstruction. Fifty-four patients underwent endoscopic procedure, and the other three patients received percutaneous transhepatic placement.
RESULTS: Insertion of the stent following guide wire positioning was successful in 95% of the patients. Two patients developed cholangitis after stent insertion and were successfully treated with conservative treatment. The jaundice was eliminated completely in 21 cases and markedly decreased in 23 cases within 2 wk after stent placement. However, nine patients had late cholangitis due to stent failure after a median interval of 147 d. Twenty-three cases underwent nasobiliary transient drainage, and three underwent plastic stent transient drainage prior to metal stent insertion. The advantages of transient drainage were drainage pre-assessment and infection control.
CONCLUSION: Our results show that an expandable metal stent is suitable for the unresectable malignant choledochal stenosis. It can eliminate jaundice and improve the patient’s quality of life. To get the highest benefit, however, the indication should be strictly selected. To get long-term patency, the proximal and distal end of the stent preceding the tumor should be no shorter than 2 cm. In the case of hilar cancer, Bismuth classification is helpful for the selection of the drainage site.