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

Affiliations
  • 1Department of Radiology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon 21431, Korea.
  • 2Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. radgwon@amc.seoul.kr
  • 3Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea.
  • 4Department of Radiology, Chungbuk National University Hospital, Cheongju 28644, Korea.

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
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