Percutaneous Insertion of Biliary Metallic Stent in Patients with Malignant Duodenobiliary Obstruction: Outcomes and Factors Influencing Biliary Stent Patency

Objectives: To investigate the technical and clinical efficacy of the percutaneous insertion of a biliary metallic stent and to identify the factors associated with biliary stent dysfunction in patients with malignant duodenobiliary obstruction. Methods: From April 2007 to December 2018, the medial records of 70 patients (39 men, 31 women; mean age, 63 years; range, 38–90 years) with malignant duodenobiliary obstruction were retrospectively reviewed. Duodenal stent insertion was performed either fluoroscopically (n = 38) or endoscopically (n = 32) using covered (n = 52) or uncovered stents (n = 18). Variables found to be significant by univariate log-rank analysis (P < 0.2) were considered candidate variables for multiple Cox's proportional hazard model. Results: The biliary stents were successfully placed in all 70 patients (uncovered stents [n = 7], covered stent [n = 33], covered stent with additional covered stent [n = 13], and covered stent with long duodenal-covered extension [n = 17]). Biliary stent insertion with subsequent duodenal stent insertion was performed in 33 patients, and duodenal stent insertion with subsequent biliary stent insertion was performed in 37 patients. Successful internal drainage was achieved in 60 (85.7%) of 70 patients. The median patient survival and stent patency time were 107 days (95% confidence interval [CI], 78–135 days) and 270 days (95% CI, 95–444 days). Biliary stent dysfunction was observed in 24 (34.3%) of 70 patients, after a mean time of 87 days. Multiple Cox's proportional hazard analysis showed the location of distal biliary stent was the only independent factor of biliary stent patency (P = 0.028; odds ratio, 3.771; 95% CI, 1.157–12.283). Median biliary stent patency rate was significantly longer in patients who had the distal end of the biliary stent beyond the distal end of the duodenal stent (mean, 358 days; 95% CI, 56–660 days), rather than had the distal end of biliary stent within duodenal stent (mean, 135 days; 95% CI, 95–175 days). Conclusion: Percutaneous insertion of the biliary metallic stent appeared to be technically feasible, safe, and effective method for the treatment of patients with malignant duodenobiliary obstruction. Moreover, the location of the distal end of the biliary stent beyond the distal end of the duodenal stent would be more effective in these patients.

Publication History

Article published online:
26 April 2021