Occlusion of biliary endoprostheses: presentation and management

A retrospective review of 20 cases of endoprosthesis occlusion in 17 patients was performed. The average length of stent patency before occlusion was 3.7 months. Clinical manifestations included one or a combination of the following: cholangitis (n = 17), jaundice (n = 9), and leakage of bile or purulent material from the percutaneous insertion site (n = 6). Eighteen of 20 episodes of endoprosthesis occlusion were successfully managed with normalization of biochemical parameters and alleviation of clinical manifestations. No therapy was attempted in two episodes of stent occlusion due to widespread metastatic disease. All 17 patients received intravenous fluid replacement and broad-spectrum antibiotic therapy. This was sufficient therapy to relieve symptoms in two cases of occlusion. Occluded stents were removed in the other 16 patients by means of radiologic (n = 10) or endoscopic (n = 6) methods. After the acute septic episode had subsided (2-5 days; mean, 3 days), new endoprostheses were percutaneously inserted in 10 cases of occlusion, long-term internal-external catheters were placed in five, and surgical bypass was performed in one. The authors conclude that endoprosthesis occlusion should not be considered a terminal event in patients with malignant biliary disease.