Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction

The purpose of this article is to review the outcomes of patients with malignant biliary obstruction treated by immediate placement of a metallic stent at the time of percutaneous biliary drainage.

By a search of our PACS, we retrospectively identified all patients who underwent biliary stent placement at our interventional radiology section between January 2003 and December 2008. Of 564 biliary stent procedures, 71 primary percutaneous stents were placed at the time of biliary drainage; the other 493 were secondary percutaneous stents, placed at various durations after biliary drainage. Medical records and procedure reports were reviewed for the primary percutaneous stent group recording time to removal of the percutaneous catheter, periprocedural complications, subsequent biliary interventions, overall survival, and catheter-free survival.

After placement of primary percutaneous stents, 97% of patients were able to have their transhepatic catheter removed, and in 73% of patients, this 5-French catheter was removed within 24 hours. Major complications after placement of primary percutaneous stents included bile peritonitis requiring IV analgesia for less than 48 hours (5.6%) and fever with leukocytosis treated with IV antibiotics (8.5%) for 48-72 hours. Median overall survival was 165 days, and 90% of patients had 100% catheter-free survival. Overall, 94% of survival days were catheter free.

Placement of primary percutaneous stents when clinically appropriate has the advantage of avoiding an externalized drainage catheter and its attendant lifestyle limitations and complications. Most patients with malignant biliary obstruction, for whom expected survival is short, will experience 100% catheter-free survival after placement of a primary percutaneous stent.