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Hepatobiliary II
PWE-142 Endoscopic stenting for malignant biliary obstruction: a 3-year review
  1. R Mahmood,
  2. N C Fisher
  1. Department of Gastroenterology, Russells Hall Hospital, Dudley, UK

Abstract

Introduction Placement of biliary stents in malignant biliary obstruction is an area of controversy as ERCP and stent placement may cause morbidity in patients with operable disease. We review here our experience in a cohort of relevant patients.

Methods A 3-year database review to identify all relevant cases for case note review. Principal outcome measures were: success of stent placement; need for further endoscopic intervention; surgical resection rates and documented complications.

Results 124 cases were identified. 100 patients underwent ERCP; stent placement was successful at first ERCP in 82% of cases. A further 5% were stented at a second ERCP and 10% required percutaneous drainage. Plastic biliary stents were used in most cases (75/87, 86%); remaining patients had metal stents. Of plastic stents, 31/75 (41%) required unscheduled re-intervention for stent occlusion, after a median interval of 90 days. 66 patients were referred for a surgical opinion; remaining patients had inoperable disease or co-morbidity. Of the referred patients, 28 (23% of whole cohort) underwent resection surgery and of these 8/28 (29%) needed pre-operative revision of their biliary stents. The median post-operative stay was 11 days and serious complications including one death occurred in three cases (11%).

Conclusion In this review only 23% of patients with malignant biliary obstruction were suitable for surgical resection. However where prior plastic biliary stents were used, a high proportion required re-intervention and this practice may have contributed to post-operative complications.

Competing interests None declared.

References 1. Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 2002;236:17–27.

2. Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2008;(3):CD005444.

3. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010;362:129–37.

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