Malign Biliyer Tıkanıklıklarda Perkütan Metalik Stentleme: Tek Merkez Deneyimi
Abstract
Objectives: In this study, we aimed to present our results and experience in percutaneous metallic stenting in patients with malignant biliary obstruction.
Materials and Methods: Between June 2013 and August 2017, 40 patients (21 female, 19 male) with malignant biliary obstruction treated with percutaneous self-expandable uncovered metallic stents were retrospectively evaluated. Demographic data, diagnoses, number and type of procedure, technical and clinical success rates, time from placement of the first catheter into the biliary system to stenting, survival time, 30-day mortality, stent patency and complications were evaluated.
Results: The mean age of the patients included in the study was 65 years (range: 40-90 years). The patients were diagnosed with pancreatic cancer (n=21), cholangiocellular cancer (n=7), gastric cancer (n=5), metastatic cancer (n=3), duodenum cancer (n=2) and hepatocellular cancer (n=2). A total of 66 stents were successfully implanted in the biliary system. The technical success, clinical success in the first week and in the first month of the procedures was 95%, 88% and 85% respectively. The survival time of the patients was 5.3 months (range: 1.5-9.5 months) and the 30-day mortality was 27.5%. Stent patency was 3.7 months (range: 1.5-6.5 months), the mean time from catheter insertion to stenting in the first month was 10 days (range: 1-22 days) and in all patients the average was 30 days (range: 1-210 days).
Conclusion: Percutaneous self-expandable uncovered metallic stenting process in patients with malignant biliary obstruction who are not suitable for surgery and endoscopic treatment or endoscopic treatment is unsuccessful, is a reliable and effective method as palliative treatment.
Keywords
Biliary Metallic Stent, Malignant Obstruction, Percutaneous
Ethical Statement
Sağlık Bilimleri Üniversitesi, Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (27.11.2017-43/10).
References
- 1. Piñol V, Castells A, Bordas JM, et al. Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial. Radiology. 2002;225:27-34.
- 2. Maetani I, Tada T, Ukita T, et al. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy. 2004;36:73-78.
- 3. Lawson AJ, Beningfield SJ, Krige JE, et al. Percutaneous transhepatic selfexpanding metal stents for palliation of malignant biliary obstruction. S Afr J Surg. 2012;50:54,56,58.
- 4. Indar AA, Lobo DN, Gilliam AD, et al. Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol. 2003;15:915-919.
- 5. Pappas P, Leonardou P, Kurkuni A, et al. Percutaneous insertion of metallic endoprostheses in the biliary tree in 66 patients: relief of the obstruction. Abdom Imaging. 2003;28:678-683.
- 6. De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc. 2001;53:547-553.
- 7. Shim DJ, Gwon DI, Han K, et al. Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction. Korean J Radiol. 2018;19:597-605.
- 8. Inal M, Akgül E, Aksungur E, et al. Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction. Acta Radiol. 2003;44:139- 146.
- 9. Adam A, Chetty N, Roddie et al. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR Am J Roentgenol. 1991;156:321-325.
- 10. Becker CD, Glättli A, Maibach R, et al. Percutaneous palliation of malignant obstructive jaundice with the Wallstent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction. J Vasc Interv Radiol. 1993;4:597-604.