Percutaneous Biliary Stent Placement in Palliation of Malignant Bile Duct Obstruction

To summarize the experiences with the technique of percutaneous biliary stent placement for treatment of malignant biliary obstruction in patients with different types of biliary obstruction.

Percutaneous biliary stent placement was performed in 126 patients with malignant biliary obstruction. The etiology included 56 cases of cholangiocarcinoma, 28 cases of pancreatic cancer, 12 cases of ampullary carcinoma, 10 cases of primary hepatic carcinoma, 8 cases of gastric cancer metastasis, 6 cases of gallbladder carcinoma, and 6 cases of liver metastasis of colon cancer. The obstructed lesion predominantly involved the common bile duct in 42 patients, common hepatic duct in 39 patients, and hilar bile duct in 45 patients. When the bile duct was punctured successfully under fluoroscopy, the guide wire was explored to across the obstruction segment under the assistant of catheter, then the stent was inserted along the super-slippery guide wire. In patients with hilar hepatic duct lesions involving both left and right hepatic ducts, the both ducts were punctured and bilateral stenting was performed. A 8.5 F internal/external drainage catheter was inserted. The liver function test and ultrasound were performed one week after the procedure to observe the decrease of bilirubin and alleviation of biliary obstruction.

A total of 166 stents were implanted in 126 patients. In the 42 patients with common bile duct obstruction, each patient was implanted one stent. In the 39 patients with common hepatic duct obstruction, each patient was impanted one stent. In the 45 patients with hilur bile duct obstruction, 38 patients were placed 2 stents, one patient was placed with 3 stents, and the rest were placed with one stent. The serum total bilirubin decreased from 309.2 ± 158.3 µmol/L before the procedure to148.5 ± 98.0 µmol/L one week after the procedure (P < 0.001). Alkaline phosphatase and alanine aminotransferase significantly decreased (P < 0.001). Five cases died within 1 month (4%) after the procedure. Complications occurred in 9 cases (7.1%). Six patients underwent combined duodenal self-expandable metal stent placement successfully.

The percutaneous biliary stent placement is a safe and effective palliative therapy for malignant biliary obstruction by improving liver function and 1ife quality.