Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice.

Objective: To assess the primary and long-term success of percutaneous metallic endoprotheses (wallstent) in malignant jaundice. Methods: Retrospective, uncensored analysis of 86 consecutive patients (42 men, 44 women, age 34 to 90 years, mean 62 years), who were percutaneously treated with wallstents for malignant jaundice within, a six-year time interval. Indications were pancreatic cancer in 9, gallbladder cancer in 15, Klatskin's tumor in 31, and metastatic disease in 31 cases. The indication for percutaneous stenting was inoperability and lack of endoscopic access. The level of the obstruction was within the liver hilus in 44, extrahepatic in 20, and within a biliodigestive anastomosis in 22 cases. Forty-five patients had undergone abdominal surgery previously. Mean survival was 8.0 months (range, 3 days to 57 months). Results: In 85 of 86 cases (99%) biliary stenting was feasible. In 82 cases (95%) laboratory tests indicated regression of the biliary obstruction. Sixty-six patients (77%) also experienced a clinical benefit from the procedure and in 65 (76%) patients long-term palliation was achieved and lasted for at least three-quarters of the remaining time of survival. Technical problems with the procedure usually stent foreshortening, were encountered in 12 cases (14%). Thirty-days morbidity was 26% (cholangitis in 15, pan creatitis in 3, liver failure in 2, effusion in 1, hemobilia in 1 case), thirty-day mortality was 15%, procedure-related in one case. The reintervention rate was 20%, the patency rate was 91%, 73%, and 58% after 3, 6, and 12 months, respectively. Conclusion: Even after exhaustion of both surgical and endoscopic therapy options percutaneously deployed wallstents enable effective long-term palliation of malignant jaundice.