A prospective, multicenter study of a double stent system for palliative treatment of malignant extrahepatic biliary obstructions. (October 2015)

• Record Type: Journal Article
• Authors: Kim, Jong Woo; Gwon, Dong I l; Han, Young-Min; Won, Je Hwan; Hong, Hyun Pyo; Ko, Gi-Young; Yoon, Hyun-Ki; Sung, Kyu-Bo
• Is Part Of: Acta radiologica. Volume 56:Number 10(2015:Oct.)
• Page Start: 1209
• Page End: 1215
• Publication Date: 2015-10
• Subjects: Malignant extrahepatic biliary obstruction -- biliary stent -- double stent system; Radiology, Medical -- Periodicals; Radiography, Medical -- Periodicals; Radiotherapy -- Periodicals; 616.0757
• DOI: 10.1177/0284185114550702
• Languages: English
• ISSNs: 0284-1851

Abstract

Background: A double stent system (covered stent in uncovered stent) was designed to provide long-term patency without tumor ingrowth or stent-related complications, such as stent migration, cholecystitis, or pancreatitis. Purpose: To investigate the safety and efficacy of double stents in patients with malignant extrahepatic biliary obstructions. Material and Methods: This prospective, nonrandomized, multicenter study enrolled 160 consecutive patients (102 men; mean age, 64 years; range, 33–91 years) with malignant extrahepatic biliary obstructions treated with a double stent system from January 2010 to March 2012. Results: The technical success rate of the double stent placement was 100%. No stent migration was observed. Procedure-related minor (self-limiting hemobilia [ n = 6] and cholangitis [ n = 2]) and major (pancreatitis [ n = 16], cholecystitis [ n = 3], and hepatic abscess [ n = 2]) complications occurred in a total of 29 patients. The mean serum bilirubin level, which was 8.9 ± 5.6 mg/dL before drainage, decreased to 2.2 ± 4.6 mg/dL 1 month after stent placement ( P < 0.001). Successful internal drainage was achieved in 148 patients (92.5%). During the mean follow-up period of 205 days, acute cholecystitis ( n = 3) and hepatic abscess ( n = 2) occurred in five patients. The median patient survival and stent patency time were 135 days (95% confidence interval [CI], 96–160 days) and 114 days (95% CI, 83–131 days), respectively. Of 153 patients, 22 (14.4%) presented with stent dysfunction due to sludge incrustation ( n = 17), tumor overgrowth ( n = 4), or blood clot ( n = 1), and required repeat intervention. Tumor ingrowth was not observed in any of these patients. Conclusion: Percutaneous treatment of malignant extrahepatic biliary obstruction using a double stent safely and effectively achieves internal biliary drainage.