Palliation of malignant bile duct obstruction with metallic biliary endoprostheses: technique, results, and complications.

Expandable metallic stents were placed in 34 patients with pathologically proved malignant bile duct obstruction to determine ease of insertion, benefits of a one-stage insertion, and cost-effectiveness relative to conventional plastic stents. Thirty-eight strictures, ranging in length from 1 to 7 cm (mean, 3.2 cm), were present in the 34 patients. Strictures were located in the lower common bile duct (n = 22), middle of the common bile duct (n = 6), and hilar confluence (n = 10). In 13 patients (38%) metallic stents were placed at the time of initial biliary drainage (one-stage procedure), while the remaining patients underwent stent placement within 1-7 days of biliary drainage (two-stage procedure). Biliary obstruction was relieved in 31 of 34 patients (91%). Three patients died within 14 days of stent insertion of unrelated causes, without any change in biliary status. Mean duration of follow-up for all patients was 5.3 months (range, 0.5-14 months). Four episodes of stent occlusion occurred in three patients (12% occlusion rate); each episode was treated successfully. The average length of hospital stay for patients who underwent a one-stage procedure was 13 days (range, 3-33 days) and was 20 days (range, 9-42 days) for patients who underwent a two-stage procedure. The facility of one-step insertion, low occlusion rate, and the many strategies available for treatment of occluded stents make metallic stents an attractive alternative to conventional plastic stents in palliating patients with malignant biliary obstruction.