Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 2088–2092 | Cite as

Biliary Stenting in Patients with Malignant Biliary Obstruction: Comparison of Double Layer, Plastic and Metal Stents

  • Saleh Elwir
  • Kaveh Sharzehi
  • Joshua Veith
  • Mathew T. Moyer
  • Charles Dye
  • Thomas McGarrity
  • Abraham Mathew
Original Article


Background and Aim

The double layer stent (DLS) has a unique design and has been used for palliation of malignant biliary obstruction, but literature on this stent is limited. Our aim was to compare plastic (PS), DLS and metal stents (MS) in terms of complication rates, time to occlusion, and patency rate in patients with malignant biliary obstruction (MBO).


A retrospective review of stents placed for MBO at our institution in the period between January 2009 and April 2011 was conducted. A total of 114 stents were identified, of which 44 were MS (39 %), 37 DLS (32 %), and 33 PS (29 %). A stent was considered occluded when an unplanned stent removal or intervention occurred due to clinical suspicion of biliary obstruction.


Stents remained patent for 95 days (range 7–359 days) in the DLS group and 59 days (range 7–228 days) in the PS group (P = 0.014) and 128.7 days (range 4–602 days) in the metal stent group. Twenty-seven percent (n = 9) of PS occluded after a mean of 60 days while 16 % (n = 7) of MS occluded after a mean of 87 days and 5 % (n = 2) of DLS occluded after a mean of 85 days (DLS vs. PS P = 0.012, DLS vs. MS P = 0.13, MS vs. PS P = 0.22).


DLS are superior to PS in patients with MBO and appear to be comparable to MS. MS had a longer patency rate but were comparable to DLS in early and late complications. We speculate that the less expensive DLS may be a cost effective alternative in the palliation of MBO.


Double layer stents Malignant biliary obstruction ERCP 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Saleh Elwir
    • 1
  • Kaveh Sharzehi
    • 2
  • Joshua Veith
    • 3
  • Mathew T. Moyer
    • 4
  • Charles Dye
    • 4
  • Thomas McGarrity
    • 4
  • Abraham Mathew
    • 4
  1. 1.Department of Internal MedicinePenn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA
  2. 2.Fox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Penn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA
  4. 4.Division of Gastroenterology and HepatologyPenn State Milton S. Hershey Medical Center and School of MedicineHersheyUSA

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