Relief of malignant obstructive jaundice by endoscopic or percutaneous insertion of metal stents

From January 1990 through July 1992 we attempted to treat 42 patients (21 men, 21 women; mean age 69 +/- 2 years) with obstructive jaundice due to inoperable malignant biliary obstructions with insertion of metal stents. 67% of the patients had stenoses of the distal common bile duct, 5% of the proximal common bile duct, and 28% had hilar lesions. Obstructions were due to pancreatic cancer (47%), gallbladder cancer (13%), cholangiocarcinoma (20%), and lymphoma of metastatic cancer (20%). We inserted a total of 51 Wallstents and 17 Strecker Stents with a technical success of 100%. The functional success was 95%. The mean bilirubin level decreased from 18.2 +/- 1.7 mg/dl before to 1.5 +/- 0.2 after stent insertion. In the first 30 days one patient (2%) with hilar malignancy developed an early reobstruction due to tumor bleeding and debris. The 30-day mortality rate was 2%. 2 (5%) patients developed recurrent jaundice within the 3-month follow-up period; 1 had tumor overgrowth of the metal stent, 1 had tumor ingrowth through the mesh. Metal biliary endoprotheses offer sufficient initial relief of malignant obstructive jaundice with reduced morbidity and mortality compared to the placement of conventional plastic stents. However, the long-term results are impaired by stent occlusion due to tumor ingrowth or overgrowth.