Metallic stents and plastic endoprostheses in percutaneous treatment of biliary obstruction

Background: In the light of the clinical controversy whether metallic stents or plastic endoprostheses should be used in the percutaneous treatment of biliary obstruction we retrospectively evaluated our experience with both drainage-systems. Methods: 71 patients (mean age 68 12 years) underwent a total of 81 interventions and received either plastic endoprostheses (11.5 or 12 French diameter; N = 57/81) or metallic stents (N = 24/81). Results: Drainage insertion was technically successful in all of the 71 patients. There was no procedure-related mortality, but a 30-day mortality of 15% (N = 11). Overall, 27 complications occurred in 81 interventions with a statistically significant higher complication-rate in plastic endoprostheses (39%; N = 21/54) compared to metallic stents (22%; N = 6/27). The average patency of the drainage-systems was 166 +/- 341 days (range 1-2,705 days) and did not differ significantly between the drainage-subtypes. Incidence of complications and a further increase in serum bilirubin following intervention was associated with a higher drainage occlusion-rate and reduced survival, irrespective of the drainage-system used. Conclusions: Percutaneous transhepatic treatment of biliary obstructions with internal drainages is a reliable therapy. The overall complication-rate of metallic stents was lower compared to plastic endoprostheses; however, no significant differences were found with respect to drainage patency or success-rate.