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CardioVascular and Interventional Radiology

, Volume 32, Issue 4, pp 707–713 | Cite as

Primary Patency of Wallstents in Malignant Bile Duct Obstruction: Single vs. Two or More Noncoaxial Stents

  • Majid Maybody
  • Karen T. Brown
  • Lynn A. Brody
  • Anne M. Covey
  • Constantinos T. Sofocleous
  • Raymond H. Thornton
  • George I. Getrajdman
Clinical Investigation

Abstract

The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents (Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction. From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively. In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days, when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant high bile duct obstruction.

Keywords

Malignant bile duct obstruction Metallic stent Wallstent Patency 

References

  1. 1.
    Clements WD, Diamond T, McCrory DC, Rowlands BJ (1993) Biliary drainage in obstructive jaundice: experimental and clinical aspects. Br J Surg 80(7):834–842PubMedCrossRefGoogle Scholar
  2. 2.
    Kaskarelis IS, Minardos IA, Abatzis PP, Malagari KS, Vrachliotis TG, Natsika MK, Kouris SG, Roubis KG, Vrachliotis GT (1996) Percutaneous metallic self-expandable endoprostheses in bile duct obstructioncaused by metastatic cancer. Hepatogastroenterology 43(10):785–791PubMedGoogle Scholar
  3. 3.
    Lee BH, Choe DH, Lee JH, Kim KH, Chin SY (1997) Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR 168(3):741–745PubMedGoogle Scholar
  4. 4.
    Lee MJ, Dawson SL, Mueller PR, Krebs TL, Saini S, Hahn PF (1992) Palliation of malignant bile duct obstruction with metallic biliary endoprostheses: technique, results, and complications. J Vasc Interv Radiol 3(4):665–671PubMedCrossRefGoogle Scholar
  5. 5.
    Rieber A, Brambs HJ (1997) Metallic stents in malignant biliary obstruction. Cardiovasc Interv Radiol 20(1):43–49CrossRefGoogle Scholar
  6. 6.
    Stoker J, Lameris JS, Jeekel J (1993) Percutaneously placed Wallstent endoprosthesis in patients with malignant distal biliary obstruction. Br J Surg 80(9):1185–1187PubMedCrossRefGoogle Scholar
  7. 7.
    Adam A, Chetty N, Roddie M, Yeung E, Benjamin IS (1991) Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. AJR 156(2):321–325PubMedGoogle Scholar
  8. 8.
    Kaskarelis IS, Papadaki MG, Papageorgiou GN, Limniati MD, Malliaraki NE, Piperopoulos PN (1999) Long-term follow-up in patients with malignant bile duct obstructionafter percutaneous placement of uncovered wallstent endoprostheses. Acta Radiol 40(5):528–533PubMedCrossRefGoogle Scholar
  9. 9.
    Gordon RL, Ring EJ, LaBerge JM, Doherty MM (1992) Malignant biliary obstruction: treatment with expandable metallic stents—follow-up of 50 consecutive patients. Radiology 182(3):697–701PubMedGoogle Scholar
  10. 10.
    Stoker J, Lameris JS (1993) Complications of percutaneously inserted biliary Wallstents. J Vasc Interv Radiol 4(6):767–772PubMedCrossRefGoogle Scholar
  11. 11.
    Boguth L, Tatalovic S, Antonucci F, Heer M, Sulser H, Zollikofer CL (1994) Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology 192(3):669–674PubMedGoogle Scholar
  12. 12.
    Nicholson AA, Royston CM (1993) Palliation of inoperable bile duct obstructionwith self-expanding metal endoprostheses: a review of 77 patients. Clin Radiol 47(4):245–250PubMedCrossRefGoogle Scholar
  13. 13.
    Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G (1997) Clinical experience with covered wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Interv Radiol 20(6):441–447CrossRefGoogle Scholar
  14. 14.
    Zollikofer C (1996) Metallic stents in malignant biliary obstruction. Autopsy findings on causes of obstruction. In: Rossi P (ed) Biliary tract radiology. Springer Medica, Berlin, p 387. (chap 29)Google Scholar
  15. 15.
    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(11):1409–1416PubMedGoogle Scholar
  16. 16.
    Brountzos EN, Ptochis N, Panagiotou I, Malagari K, Tzavara C, Kelekis D (2007) A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Interv Radiol 30(1):66–73CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Majid Maybody
    • 1
  • Karen T. Brown
    • 1
  • Lynn A. Brody
    • 1
  • Anne M. Covey
    • 1
  • Constantinos T. Sofocleous
    • 1
  • Raymond H. Thornton
    • 1
  • George I. Getrajdman
    • 1
  1. 1.Memorial Sloan-Kettering Cancer CenterInterventional Radiology SectionNew YorkUSA

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