Korean J Med.  1998 Apr;54(4):533-541.

Comparative Evaluation of Various Biliary Stents in the Palliative Treatment of Malignant Biliary Obstruction

• Shim CS
• Cho YD
• Moon JH
• Lee YH
• Bong HK
• Kim JO
• Cho JY
• Kim YS
• Lee JS
• Lee MS

Abstract

OBJECTIVES
Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. At present, the major drawback of endoscopic biliary stenting is occlusion of the endoprosthesis with sludge, resulting in recurrence of jaundice or cholangitis. Recently, there are variable stents that have different materials, sizes, and designs have been used in efforts to overcome this problem. To determine the success rate of stent insertion, successful drainage rate, duration of patency, complications related to stent insertion, and cause of stent malfunction, plastic endoprosthesis compared to metal stents in palliative treatment of malignant biliary obstruction. METHOD: We retrospectively evaluated 157 patients (total number of stent insertion: 308 cases) with unresec table malignant biliary obstruction to receive either a plastic stent(group I, 261 cases) or metal stent(group II, 47 cases). The patients who were recieved plastic stent were subdivided to general plastic stents(group Ia, polyethylene, polyurethane, polyvinylchloride, 225 cases) and Tannenbaum stent(group Ib, Teflon, 36 times) group. And the patients who were received metal stent were subdivided to uncovered metal stents(group IIa, Gianturco R sch, Wall, Strecker, EndoCoil stent, 26 times) and membrane covered self-expandable metal stent(group IIb, 21 cases) group.
RESULTS
1) There were no statistical difference in successful rate of stent insertion and drainage effect of stent accord ing to the types of stent(p>0.05). 2) Median patency of the stent was significantly prolonged in patients with a metal stent(group II) com pared with those with a plastic stent(group I) (249 vs 123 days; p < 0.05). Median patency of the gorup Ib was significantly prolonged than those of group Ia(137 vs 109 days ; p < 0.05), but there was no statistical difference in median patency between group IIa and IIb(233 vs 267 days; p > 0.05). 3) The rate of early complication related to stent insertion showed no significant difference in plastic and metal stent groups(P > 0.05). 4) Major causes of stent malfunction in plastic and metal stent were sludge(90% vs 21.4%), tumor ingrowth (4.4% vs 71.4%), and dislocation(5.6% vs 7.2%), respec tively.
CONCLUSION
Metal stents have a longer patency than plastic stent in patients with malignant biliary obstruc tion. In plastic stents, Tannenbaum stents have a slighlty longer patency than other plastic stents, but there were no differences in the success rates, drainage effect and complication rates according to types of stents.

Keyword

Malignant obstructive jaundice; Plastic stent; Metal stent

MeSH Terms

Cholangitis
Drainage
Humans
Jaundice
Jaundice, Obstructive
Membranes
Palliative Care*
Plastics
Polyethylene
Polytetrafluoroethylene
Polyurethanes
Recurrence
Retrospective Studies
Sewage
Stents*
Plastics
Polyethylene
Polytetrafluoroethylene
Polyurethanes
Sewage