Korean J Radiol.  2018 Aug;19(4):597-605. 10.3348/kjr.2018.19.4.597.

Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction

• Shim DJ
• Gwon DI
• Han K
• Kim Y
• Ko GY
• Shin JH
• Ko HK
• Kim JH
• Kim JW
• Yoon HK
• Sung KB

• KMID: 2413689
• DOI: http://doi.org/10.3348/kjr.2018.19.4.597

Abstract

OBJECTIVE
To investigate the outcomes of percutaneous metallic stent placements in patients with malignant biliary hilar obstruction (MBHO).
MATERIALS AND METHODS
From January 2007 to December 2014, 415 patients (mean age, 65 years; 261 men [62.8%]) with MBHO were retrospectively studied. All the patients underwent unilateral or bilateral stenting in a T, Y, or crisscross configuration utilizing covered or uncovered stents. The clinical outcomes evaluated were technical and clinical success, complications, overall survival rates, and stent occlusion-free survival.
RESULTS
A total of 784 stents were successfully placed in 415 patients. Fifty-five patients had complications. These complications included hemobilia (n = 19), cholangitis (n = 13), cholecystitis (n = 11), bilomas (n = 10), peritonitis (n = 1), and hepatic vein-biliary fistula (n = 1). Clinical success was achieved in 370 patients (89.1%). Ninety-seven patients were lost to follow-up. Stent dysfunction due to tumor ingrowth (n = 107), sludge incrustation (n = 44), and other causes (n = 3) occurred in 154 of 318 patients. The median overall survival and the stent occlusion-free survival were 212 days (95% confidence interval [CI], 186−237 days) and 141 days (95% CI, 126−156 days), respectively. The stent type and its configuration did not affect technical success, complications, successful internal drainage, overall survival, or stent occlusion-free survival.
CONCLUSION
Percutaneous stent placement may be safe and effective for internal drainage in patients with MBHO. Furthermore, stent type and configuration may not significantly affect clinical outcomes.

Keyword

Biliary stent; Percutaneous transhepatic biliary drainage; PTBD; Klatskin tumor; Cholangiocarcinoma; Biliary hilar malignancy; Obstructive jaundice

MeSH Terms

Cholangiocarcinoma
Cholangitis
Cholecystitis
Drainage
Fistula
Hemobilia
Humans
Jaundice, Obstructive
Klatskin Tumor
Lost to Follow-Up
Male
Peritonitis
Retrospective Studies
Sewage
Stents*
Survival Rate
Sewage

Figure

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  Fig. 1 Algorithm of patient selection.

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  Fig. 2 Comparison of overall patient survival between unilateral and bilateral stent placement groups (adjusted hazard ratio; 0.964 [95% CI = 0.741−1.256] with baseline of unilateral stenting, p = 0.788).CI = confidence interval

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  Fig. 3 Comparison of overall patient survival between covered and uncovered stent groups (adjusted hazard ratio; 0.795 [95% CI = 0.611−1.034] with baseline of uncovered stent, p = 0.087).

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  Fig. 4 Comparison of stent occlusion-free survival between unilateral and bilateral stent groups (adjusted hazard ratio; 1.062 [95% CI = 0.817−1.381] with baseline of unilateral stenting, p = 0.653).

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  Fig. 5 Comparison of stent occlusion-free survival between covered and uncovered stent groups (adjusted hazard ratio; 0.952 [95% CI = 0.733−1.236] with baseline of uncovered stent, p = 0.709).

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