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Biliary obstruction: treatment with self-expanding metal prostheses
E K Salomonowitz1, F Antonucci, M Heer
1Department of Radiology, Kantonsspital Winterthur, Switzerland.
Summary
Wallstent endoprostheses were used to treat biliary obstruction. While sludge formation caused occlusion in benign cases, tumor growth over the stent, not into it, was observed in malignant cases.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Oncology
Background:
- Biliary obstruction, whether benign or malignant, presents significant clinical challenges.
- Endoscopic and percutaneous stenting are established methods for palliation and treatment.
Purpose of the Study:
- To evaluate the efficacy and complications of Wallstent endoprostheses in patients with obstructive biliary stenoses.
Main Methods:
- Percutaneous and endoscopic insertion of 58 Wallstent endoprostheses in 42 patients.
- Follow-up included monitoring for stent patency, recurrent jaundice, and survival outcomes.
Main Results:
- In benign cases (3 patients), two stents occluded due to sludge, requiring reintervention.
- In malignant cases (39 patients), 28% experienced recurrent jaundice due to tumor overgrowth or liver failure.
- Autopsies showed tumor growth on the stent surface but not lumen occlusion by ingrowth.
Conclusions:
- Wallstent endoprostheses can be effective for biliary obstruction but are prone to sludge occlusion in benign cases.
- Tumor growth over the stent is a complication in malignant biliary obstruction, but ingrowth into the lumen was not observed.