Abdominal Imaging

, Volume 31, Issue 4, pp 433–438 | Cite as

Percutaneous insertion of Zilver stent in malignant biliary obstruction

  • Y. H. Han
  • M.-Y. Kim
  • S. Y. Kim
  • Y. H. Kim
  • Y. J. Hwang
  • J. W. Seo
  • S. J. Cha
  • G. Hur



We evaluated the clinical efficacy and technical feasibility of the percutaneously inserted self-expandable nitinol stent (Zilver stent) for palliation of malignant biliary obstruction.


Seventeen patients with malignant tumors involving the intra- or extrahepatic bile duct who presented with obstructive jaundice underwent percutaneous insertion of a self-expandable nitinol stent. We retrospectively reviewed the hospital records of patients and evaluated the technical feasibility on stent placement, complications, patient survival, and duration of stent patency.


Percutaneous biliary stenting with 27 Zilver stents was performed in 17 patients with malignant biliary obstruction. Technical success was 95%. Malposition of the stent was encountered in one patient. Minor technical problems were encountered in two patients: the introducer tip was broken during stent insertion, so endoscopic removal was done. Mean follow-up period for the 17 patients was 182 days (range 29–485 days): nine patients died of progressive disease at a mean follow-up of 151 days (range 61–371days) after stent insertion and eight patients remained alive at the final follow-up of 216 days (range 29–485 days). The median survival period for all patients was 277 days. The stent occlusion rate was 26% and the mean patency period was 280 days. In five patients, seven stents were obstructed by tumor ingrowth and overgrowth. Stent patency rates were 100%, 100%, 75%, 61%, and 41% at 1, 2, 3, 6, and 12 months, respectively. A late complication, erosive bleeding of the hepatic artery by the stent, developed in one patient.


Percutaneous biliary stenting using the nitinol stent is technically feasible and safe and clinically efficacious treatment for malignant biliary obstruction, even with a minor technical problem during stent insertion.


Malignant biliary obstruction Biliary stenting Nitinol stent Zilver stent 


  1. 1.
    Carrasco CH, Wallace S, Charnsangavej C. Expandable biliary endoprosthesis: an experimental study. AJR 1985;145:1279–1281PubMedGoogle Scholar
  2. 2.
    Davids PHP, Groen AK, Rauws EA, et al. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992;340:1488–1492PubMedCrossRefGoogle Scholar
  3. 3.
    Adam A, Chettly N, Roddie M, et al. Self-expanding stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR 1991;156:321–325PubMedGoogle Scholar
  4. 4.
    Coons HG. Self-expanding stainless steel biliary stents. Radiology 1989;170:979–983PubMedGoogle Scholar
  5. 5.
    Gillams A, Dick R, Dooley JS, et al. Self-expandable stainless steel braided endoprosthesis for biliary strictures. Radiology 1990;174:137–140PubMedGoogle Scholar
  6. 6.
    Irving JD, Adam A, Dick R, et al. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology 1989;172:321–326PubMedGoogle Scholar
  7. 7.
    Lammer JS, Klein GE, Kleinert R, et al. Obstructive jaundice: use of expandable metal endoprosthesis for biliary drainage. Radiology 1990;177:789–792PubMedGoogle Scholar
  8. 8.
    Lameris JS, Stocker J, Nijs HG. Malignant biliary obstruction: percutaneous use of self-expandable stents. Radiology 1991;179:703–707PubMedGoogle Scholar
  9. 9.
    Yoshioka T, Sakaguchi H, Yoshimura H. Expandable metallic biliary endoprostheses: preliminary clinical evaluation. Radiology 1990;177:253–257PubMedGoogle Scholar
  10. 10.
    Bezzi M, Orsi F, Salvatori FM, et al. Self-expandable nitinol stent for the management of biliary obstruction: long-term clinical results. J Vasc Interv Radiol 1994;5:287–293PubMedCrossRefGoogle Scholar
  11. 11.
    Rossi P, Bezzi M, Rossi M. Metallic stents in malignant biliary obstruction: results of a multicenter European study of 240 patients. J Vasc Interv Radiol 1994;5:279–285PubMedCrossRefGoogle Scholar
  12. 12.
    Mathieson JR, McLoughlin RF, Cooperberg PL. Malignant obstruction of the common bile duct: long-term results of Gianturco-Rosch metal stents used as initial treatment. Radiology 1994;192:663–667PubMedGoogle Scholar
  13. 13.
    Watkinson A. Hepatobiliary intervention. In: Watkinson A, Adam A (eds). Interventional radiology, a practical guide. Oxford: Oxon Radcliffe Medical Press, 1996:pp 59Google Scholar
  14. 14.
    Gordon RL, Ring EJ, LaBerge JM, Doherty MM. Malignant biliary obstruction: treatment with expandable metallic stents: follow-up of 50 consecutive patients. Radiology 1992;182:697–701PubMedGoogle Scholar
  15. 15.
    Inal M, Akgul E, Aksungur E, Seydaoglu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 2003;14:1409–1416PubMedGoogle Scholar
  16. 16.
    Lee MJ, Dawson SL, Mueller PR, et al. Palliation of malignant bile duct obstruction with metallic biliary endoprostheses: technique, results, and complications. J Vasc Interv Radiol 1992;3:665–671PubMedCrossRefGoogle Scholar
  17. 17.
    Stoker J, Lameris JS, van Blankestein M. Percutaneous metallic self-expandable endoprostheses in malignant hilar biliary obstruction. Gastrointest Endosc 1993;39:43–49PubMedCrossRefGoogle Scholar
  18. 18.
    Brountzos EN, Petropoulos E, Kelekis NL. Malignant biliary obstruction: management with percutaneous metallic stent placement. Hepatogastroenterology 1999;46:2764–2771PubMedGoogle Scholar
  19. 19.
    Oikarinen H, Leinonen S, Karttunen A. Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction. J Vasc Interv Radiol 1999;10:1387–1393PubMedCrossRefGoogle Scholar
  20. 20.
    Han YM, Hwang SB, Lee ST, et al. Polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction: preliminary results. Cardiovasc Interv Radiol 2002;25:381–387CrossRefGoogle Scholar
  21. 21.
    Han YM, Jin GY, Lee SO, Kwak HS, Chung GH. Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction. J Vasc Interv Radiol 2003;14:1291–1301PubMedGoogle Scholar
  22. 22.
    Varadarajulu S, Tutuian R, Gostout C, et al. Efficacy of the Za self-expandable metal stent for palliation of malignant biliary obstruction. J Clin Gastroenterol 2004;38:77–80PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Y. H. Han
    • 1
  • M.-Y. Kim
    • 1
  • S. Y. Kim
    • 1
  • Y. H. Kim
    • 1
  • Y. J. Hwang
    • 1
  • J. W. Seo
    • 1
  • S. J. Cha
    • 1
  • G. Hur
    • 1
  1. 1.Department of RadiologyIlsan Paik Hospital, Medical College of Inje UniversityGoyang-siKorea

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