Skip to main content

Advertisement

SpringerLink
Log in

Safety and Efficacy of Percutaneous Biliary Covered Stent Placement in Patients with Malignant Biliary Hilar Obstruction; Correlation with Liver Function

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To estimate the safety and efficacy of percutaneous ePTFE-covered biliary stent placement and the relationship between underlying liver function and stent patency in patients with malignant hilar obstruction.

Materials and Methods

From March 2012 to June 2015, 41 patients [22 females, 19 males; mean age 69.8 (range 34–94) years] with malignant biliary obstruction underwent percutaneous biliary stent placement (31 patients with unilateral, 10 patients with bilateral side-by-side). Cumulative patient survival and stent patency rate curves were derived using the Kaplan–Meier method. A Cox model was used to explore the relationship between liver function and patient survival, and also biliary stent patency. Pearson correlation coefficient was used to analyze the relationship between patient survival and stent patency.

Results

Technical success rate was 100 % and clinical success rate was 95 %. During follow-up, four complications occurred (two bilomas and two cases of acute cholecystitis) and were treated successfully with percutaneous drainage. No other complication occurred. Mean serum bilirubin level was 11.34 ± 7.35 mg/dL before drainage and 5.00 ± 4.83 mg/dL 2 weeks after stent placement. The median patent survival duration was 147 days (95 % CI, 69.6–224.4 days). The median stent patency duration was 101 days (95 % CI, 70.0–132.0 days). The cumulative stent patency rates at 1, 3, 6, and 12 months were 97, 57.6, 30.3, and 17.0 %, respectively. Child–Pugh score was correlated significantly with patient survival (P = 0.011) and stent patency (P = 0.007). MELD score was correlated significantly with stent patency (P = 0.044). There was a correlation between patient survival and stent patency (r = 0.778, P < 0.001).

Conclusion

Percutaneous placement of ePTFE-covered biliary stent was a safe and an effective method for malignant biliary obstruction. Underlying liver function seemed to be one of the important factors affecting patient survival and stent patency, and stent patency showed statistically significant correlation with patient survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kumaran V, Gulati S, Paul B, Pande K, Sahni P, Chattopadhyay K. The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder. Eur Radiol. 2002;12(8):1993–9.

    Article  PubMed  Google Scholar 

  2. Adam A, Chetty N, Roddie M, Yeung E, Benjamin IS. Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR Am J Roentgenol. 1991;156(2):321–5.

    Article  CAS  PubMed  Google Scholar 

  3. Mathieson JR, McLoughlin RF, Cooperberg PL, et al. Malignant obstruction of the common bile duct: long-term results of Gianturco-Rosch metal stents used as initial treatment. Radiology. 1994;192(3):663–7.

    Article  CAS  PubMed  Google Scholar 

  4. Lammer J, Hausegger KA, Fluckiger F, et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology. 1996;201(1):167–72.

    Article  CAS  PubMed  Google Scholar 

  5. Hausegger KA, Thurnher S, Bodendorfer G, et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol. 1998;170(2):403–8.

    Article  CAS  PubMed  Google Scholar 

  6. Molnar W, Stockum AE. Relief of obstructive jaundice through percutaneous transhepatic catheter—a new therapeutic method. Am J Roentgenol. 1974;122(2):356–67.

    Article  CAS  Google Scholar 

  7. Pereiras RV Jr, Rheingold OJ, Huston D, et al. Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree. Ann Intern Med. 1978;89(5 Pt 1):583–9.

    Google Scholar 

  8. Lammer J. Biliary endoprostheses. Plastic versus metal stents. Radiol Clin North Am. 1990;28(6):1211–22.

    CAS  PubMed  Google Scholar 

  9. Morgan RA, Adam AN. Malignant biliary disease: percutaneous interventions. Tech Vasc Interv Radiol. 2001;4(3):147–52.

    Article  CAS  PubMed  Google Scholar 

  10. Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G. Clinical experience with covered Wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol. 1997;20(6):441–7.

    Article  CAS  PubMed  Google Scholar 

  11. Born P, Neuhaus H, Rosch T, et al. Initial experience with a new, partially covered Wallstent for malignant biliary obstruction. Endoscopy. 1996;28(8):699–702.

    Article  CAS  PubMed  Google Scholar 

  12. Schoder M, Rossi P, Uflacker R, et al. Malignant biliary obstruction: treatment with ePTFE-FEP–covered endoprostheses—initial technical and clinical experiences in a multicenter trial 1. Radiology. 2002;225(1):35–42.

    Article  PubMed  Google Scholar 

  13. Lee MJ, Dawson SL, Mueller PR, et al. Percutaneous management of hilar biliary malignancies with metallic endoprostheses: results, technical problems, and causes of failure. Radiographics. 1993;13(6):1249–63.

    Article  CAS  PubMed  Google Scholar 

  14. Hausegger KA, Kleinert R, Lammer J, Klein GE, Fluckiger F. Malignant biliary obstruction: histologic findings after treatment with self-expandable stents. Radiology. 1992;185(2):461–4.

    Article  CAS  PubMed  Google Scholar 

  15. Gosain S, Bonatti H, Smith L, et al. Gallbladder stent placement for prevention of cholecystitis in patients receiving covered metal stent for malignant obstructive jaundice: a feasibility study. Dig Dis Sci. 2010;55(8):2406–11.

    Article  PubMed  Google Scholar 

  16. Dumonceau JM, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44(3):277–98.

    Article  PubMed  Google Scholar 

  17. Brountzos EN, Ptochis N, Panagiotou I, Malagari K, Tzavara C, Kelekis D. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Intervent Radiol. 2007;30(1):66–73.

    Article  PubMed  Google Scholar 

  18. Gandini R, Fabiano S, Pipitone V, et al. Management of biliary neoplastic obstruction with two different metallic stents implanted in one session. Cardiovasc Intervent Radiol. 2005;28(1):48–52.

    Article  PubMed  Google Scholar 

  19. Tesdal IK, Adamus R, Poeckler C, Koepke J, Jaschke W, Georgi M. Therapy for biliary stenoses and occlusions with use of three different metallic stents: single-center experience. J Vasc Interv Radiol. 1997;8(5):869–79.

    Article  CAS  PubMed  Google Scholar 

  20. Carr-Locke DL. Metal stents for distal biliary malignancy: have we got you covered? Gastrointest Endosc. 2005;61(4):534–6.

    Article  PubMed  Google Scholar 

  21. Gwon DI, Ko GY, Kim JH, et al. A comparative analysis of PTFE-covered and uncovered stents for palliative treatment of malignant extrahepatic biliary obstruction. AJR Am J Roentgenol. 2010;195(6):W463–9.

    Article  PubMed  Google Scholar 

  22. Krokidis M, Fanelli F, Orgera G, Bezzi M, Passariello R, Hatzidakis A. Percutaneous treatment of malignant jaundice due to extrahepatic cholangiocarcinoma: covered Viabil stent versus uncovered Wallstents. Cardiovasc Intervent Radiol. 2010;33(1):97–106.

    Article  PubMed  Google Scholar 

  23. Krokidis M, Fanelli F, Orgera G, et al. Percutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP–covered versus uncovered nitinol biliary stents. Cardiovasc Intervent Radiol. 2011;34(2):352–61.

    Article  PubMed  Google Scholar 

  24. Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci. 2012;57(12):3279–85.

    Article  PubMed  Google Scholar 

  25. Fanelli F, Orgera G, Bezzi M, Rossi P, Allegritti M, Passariello R. Management of malignant biliary obstruction: technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience. Eur Radiol. 2008;18(5):911–9.

    Article  PubMed  Google Scholar 

  26. Son RC, Gwon DI, Ko HK, Kim JW, Ko GY. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion. Korean J Radiol. 2015;16(3):586–92.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–70.

    Article  CAS  PubMed  Google Scholar 

  28. Cholongitas E, Papatheodoridis G, Vangeli M, Terreni N, Patch D, Burroughs A. Systematic review: the model for end-stage liver disease–should it replace Child–Pugh’s classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther. 2005;22(11–12):1079–89.

    Article  CAS  PubMed  Google Scholar 

  29. Farnsworth N, Fagan SP, Berger DH, Awad SS. Child–Turcotte–Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg. 2004;188(5):580–3.

    Article  PubMed  Google Scholar 

  30. Wedd J, Bambha KM, Stotts M, et al. Stage of cirrhosis predicts the risk of liver-related death in patients with low Model for end-stage liver disease scores and cirrhosis awaiting liver transplantation. Liver Transpl. 2014;20(10):1193–201.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Srikureja W, Kyulo NL, Runyon BA, Hu KQ. MELD score is a better prognostic model than Child–Turcotte–Pugh score or discriminant function score in patients with alcoholic hepatitis. J Hepatol. 2005;42(5):700–6.

    Article  PubMed  Google Scholar 

  32. Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut. 2003;52(1):134–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cardenas A, Gines P, Uriz J, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001;34(4 Pt 1):671–6.

    Article  CAS  PubMed  Google Scholar 

  34. Fraley DS, Burr R, Bernardini J, Angus D, Kramer DJ, Johnson JP. Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation. Kidney Int. 1998;54(2):518–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2013R1A1A1007658).

Author information

Authors and Affiliations

  1. Department of Radiology and Medical Research Institute, School of Medicine Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, Republic of Korea

    Hyeran Hyun & Sun Young Choi

  2. Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Gyeonggi-do, 442-723, Republic of Korea

    Kyung Ah Kim

  3. Department of Biology, College of Arts and Science Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA

    Soo Bin Ko

Authors
  1. Hyeran Hyun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sun Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung Ah Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Soo Bin Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sun Young Choi.

Ethics declarations

Conflict of Interest

This study was founded by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2013R1A1A1007658).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hyun, H., Choi, S.Y., Kim, K.A. et al. Safety and Efficacy of Percutaneous Biliary Covered Stent Placement in Patients with Malignant Biliary Hilar Obstruction; Correlation with Liver Function. Cardiovasc Intervent Radiol 39, 1298–1305 (2016). https://doi.org/10.1007/s00270-016-1375-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-016-1375-5

Keywords

Search

Navigation