Percutaneous insertion of metallic endoprostheses in the biliary tree in 66 patients: relief of the obstruction

Abstract

Background: We evaluated the efficacy of percutaneous transhepatic insertion of metallic endoprosthesis in 66 patients with biliary obstruction.

Methods: From September 1994 through September 2002, 97 patients with obstructive jaundice attended the radiology department of our hospital; 92 had malignancy and five had benign obstruction (age range, 29–92 years; mean age, 68.3 years). In three patients, findings of percutaneous cholangiography did not indicate further access. Eighty-six metallic stents were implanted in 66 of the 94 remaining patients, and the other 27 patients were treated with percutaneous biliary drainage: external drainage in 21 patients to assist in subsequent operations and combined internal and external drainage in six patients. In one patient we performed percutaneous balloon dilatation of the stenosis of the choledochjejunal anastomosis. Hemobilia occurred in one patient and required embolization of the right hepatic artery. In nine patients (13.6%), a new procedure was used after 40 to 278 days (mean, 129 days) because of occlusion of the endoprosthesis.

Results: Clinical improvement and decrease in serum bilirubin level were achieved in 61 of the 66 patients (92.4%). The survival time in patients with malignancy ranged from 6 to 485 days (mean, 139 days). No intervention-related death occurred. Except for the aforementioned hemobilia, one case of biloma occurred and required immediate percutaneous drainage.

Conclusion: Percutaneous transhepatic insertion of metallic stents was an efficient and secure method to treat biliary obstruction, particularly in malignant inoperable cases.