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CardioVascular and Interventional Radiology

, Volume 30, Issue 1, pp 66–73 | Cite as

A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

  • Elias N. BrountzosEmail author
  • Nikolaos Ptochis
  • Irene Panagiotou
  • Katerina Malagari
  • Chara Tzavara
  • Dimitrios Kelekis
CLINICAL INVESTIGATION

Abstract

Background

Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known.

Methods

Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels.

Results

Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors of survival.

Conclusions

Percutaneous metallic biliary stenting provides good palliation of malignant jaundice. Partial liver drainage achieved results as good as those after complete liver drainage. A serum bilirubin level of less than 4 mg/dl after stenting is the most important independent predictor of survival, while increasing age and Bismuth IV lesions represent dismal prognostic factors.

Keywords

Malignant biliary obstruction Metal stents Survival 

References

  1. 1.
    Bismuth H, Castaing D, Traynor O (1994) resection or palliation: Priority of surgery in the treatment of hilar cancer. World J Surg 12:39–47CrossRefGoogle Scholar
  2. 2.
    Ogura Y, Mizumoto R, Tabata M, et al. (1993) Surgical treatment of carcinoma of the hepatic duct confluence: Analysis of 55 resected carcinomas. World J Surg 17: 85–93PubMedCrossRefGoogle Scholar
  3. 3.
    Salomonowitz EK, Adam A, Antonucci F, Stuckmann G, Zollikofer CL (1992) Malignant biliary obstruction: Treatment with self-expandable stainless steel endoprosthesis. Cardiovasc Intervent Radiol 15:351–355PubMedGoogle Scholar
  4. 4.
    Molnar W, Stockum AE (1974) Relief of obstructive jaundice through percutaneous transhepatic catheter: A new therapeutic method. AJR Am J Roentgenol 122:356–367Google Scholar
  5. 5.
    Adam A (1994) Metallic biliary endoprosthesis. Cardiovasc Intervent Radiol 17:127–132PubMedCrossRefGoogle Scholar
  6. 6.
    Coons H (1992) Metallic stents for the treatment of biliary obstruction: A report of 100 cases. Cardiovasc Intervent Radiol 15:367–374PubMedGoogle Scholar
  7. 7.
    Lammer J, Hausegger KA, Fluckiger F, et al. (1996) Common bile duct obstruction due to malignancy: Treatment with plastic versus metal stents. Radiology 201:167–172PubMedGoogle Scholar
  8. 8.
    Schmassmann A, von Gunten E, Knuchel J, et al. (1996) Wallstents versus plastic stents in malignant biliary obstruction: Effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 91:654–659PubMedGoogle Scholar
  9. 9.
    Lee BH, Choe DH, Lee JH, et al. (1997) Metallic stents in malignant biliary obstruction: Prospective long-term clinical results. AJR Am J Roentgenol 168:741–745PubMedGoogle Scholar
  10. 10.
    Rossi P, Bezzi M, Rossi M, et al. (1994) Metallic stents in malignant biliary obstruction: Results of a multicenter European study of 240 patients. J Vasc Interv Radiol 5:279–285PubMedGoogle Scholar
  11. 11.
    Bezzi M, Orsi F, Salvatori FM, et al. (1994) Self-expandable nitinol stent for the management of biliary obstruction: Long-term clinical results. J Vasc Interv Radiol 5:287–293PubMedGoogle Scholar
  12. 12.
    Inal M, Akgul E, Aksungur E, et al. (2003) Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction: Complications, follow-up, and re-intervention in 154 patients. Acta Radiol 44:139–146PubMedCrossRefGoogle Scholar
  13. 13.
    Lammer J, Klein GE, Kleinert R, et al. (1990) Obstructive jaundice: Use of expandable metal endoprosthesis for biliary drainage. Work in progress. Radiology 177:789–792PubMedGoogle Scholar
  14. 14.
    Brountzos EN, Petropoulos E, Kelekis NL, et al. (1999) Malignant biliary obstruction: Management with percutaneous metallic stent placement. Hepatogastroenterology 46:2764–2771PubMedGoogle Scholar
  15. 15.
    Rai R, Dick R, Doctor N, et al. (2000) Predicting early mortality following percutaneous stent insertion for malignant biliary obstruction: A multivariate risk factor analysis. Eur J Gastroenterol Hepatol 12:1095–1100PubMedGoogle Scholar
  16. 16.
    Alfke H, Alfke B, Froelich JJ, et al. (2003) Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents: Results of an 8-year follow-up and analysis of the prognostic parameters. ROFO 175:1125–1129PubMedGoogle Scholar
  17. 17.
    Indar AA, Lobo DN, Gilliam AD, et al. (2003) Percutaneous biliary metal wall stenting in malignant obstructive jaundice. Eur J Gastroenterol Hepatol 15:915–919PubMedCrossRefGoogle Scholar
  18. 18.
    Kim HS, Lee DK, Kim HG, et al. (2002) Features of malignant biliary obstruction affecting the patency of metallic stents: A multicenter study. Gastrointest Endosc 55:395–365Google Scholar
  19. 19.
    Bonnel D, Ferrucci JT, Mueller PR, et al. (1984) Surgical and radiological decompression in malignant biliary obstruction: A retrospective study using multivariate risk factors analysis. Radiology 152:347–351PubMedGoogle Scholar
  20. 20.
    Lameris JS, Stoker J, Nijs HG, et al. (1991) Malignant biliary obstruction: Percutaneous use of self-expandable stents. Radiology 179:703–707PubMedGoogle Scholar
  21. 21.
    Becker CD, Glattli A, Maibach R, Baer HU (1993) Percutaneous palliation of malignant obstructive jaundice with the Wall-stent endoprosthesis: Follow-up and reintervention in patients with hilar and non-hilar obstruction. J Vasc Interv Radiol 4:597–601PubMedCrossRefGoogle Scholar
  22. 22.
    Freeman ML, Sielaff TD (2003) A modern approach to malignant hilar biliary obstruction. Rev Gastroenterol Disord 4:187–201Google Scholar
  23. 23.
    Inal M, Akgul E, Aksungur E, Seydaoglu G (2003) Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: Unilobar versus bilobar drainage. J Vasc Interv Radiol 14:1409–1416PubMedGoogle Scholar
  24. 24.
    Rieber A, Brambs HJ (1997) Metallic stents in biliary obstruction. Cardiovasc Intervent Radiol 20:43–49PubMedCrossRefGoogle Scholar
  25. 25.
    Ferro C, Perona F, Ambrogi C, Barile A, Cianni R (1995) Malignant biliary obstruction treated by Wallstents and Strecker Tantalum stents: A retrospective review. Cardiovasc Intervent Radiol 18:25–29PubMedGoogle Scholar
  26. 26.
    Hausegger KA, Mischinger HJ, Karaic R, et al. (1997) Percutaneous cholangioscopy in obstructed biliary metal stents. Cardiovasc Intervent Radiol 20:191196CrossRefGoogle Scholar
  27. 27.
    Kanasaki S, Furukawa A, Kane T, Murata K (2000) Polyurethane-covered Nitinol Strecker stents as primary palliative treatment of malignant biliary obstruction. Cardiovasc Intervent Radiol 23:114–120PubMedCrossRefGoogle Scholar
  28. 28.
    Han YM, Hwang SB, Lee ST, Lee JM, Chung GH (2002) Polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction: Preliminary results. Cardiovasc Intervent Radiol 25:381–387PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Elias N. Brountzos
    • 1
    Email author
  • Nikolaos Ptochis
    • 1
  • Irene Panagiotou
    • 1
  • Katerina Malagari
    • 1
  • Chara Tzavara
    • 2
  • Dimitrios Kelekis
    • 1
  1. 1.2nd Department of RadiologyAthens University School of Medicine, Attikon University HospitalAthensGreece
  2. 2.Department of Hygiene and EpidemiologyAthens University School of MedicineAthensGreece

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