Introduction Self-expandable metal stent (SEMS) are widely used as first line palliative therapy for unresectable malignant biliary strictures. We present our experience of use of self-expandable metal stents in malignant biliary strictures in a District General Hospital (DGH) setting.
Method We conducted a retrospective review on the data of all patients who had undergone an ERCP with a placement of self-expandable metal stent for inoperable malignant biliary strictures between Jan 2009 and Aug 2014. Comprehensive information was gathered with regards to patient’s demographics, procedural indications and procedure success rates. We assessed the stents efficacy, stent patency rates, complications and patient survival rates
Results 50 patients were identified and analysed during this period. 60% were females and the mean age was 72 years (range, 35–93 years). The most common underlying diagnoses were Pancreatic carcinoma (60%) and Cholangiocarcinoma (32%) followed by Ampullary Carcinoma (6%) and Lymphoma (2%). Indications for metal stent placement included malignant bile duct stricture (54%), blockage of old stents (42%) and stent migration (4%).
23/50 (42%) patients had previous stent placement (Plastic 18, Metal 5). Of these, 21 stents failed due to blockage either due to biliary sludge or tumour overgrowth while 2 stents had migrated out (both plastic stents). The mean duration of previous stent patency was; plastic 96 days (7–523 days) and metal 237 days (39–595 days).
The types of metal stents used were; Fully Covered (28%), Partially Covered (32%) and Uncovered (40%). The mean duration of all metal stents patency was 122 days (range, 7 – 566 days) and there was no statistical difference in terms of duration of stent patency among fully covered, partially covered and uncovered stents.
Overall complication rate was 18%, which included Cholangitis (2%) and Stent Blockage (8/50, 16%) mainly due to biliary sludge (6/8). Of these blocked stents 5 were Fully covered, 3 Partial covered, 1 was Uncovered. There were no cases of post ERCP pancreatitis or migration of metal stent. There were no reported cases of procedure related mortality. The mean survival period after metal stent insertion was 161 days (range 9 to 566).
Conclusion Self-expandable metal stents offers safe and effective palliative therapy for inoperable malignant biliary strictures and can be safely performed in a district general hospital with low complication rates. High blockage rate of fully covered stents is in our series is unexpected and the reasons for this were not obvious but this would be the subject of further analysis and study.
Disclosure of interest None Declared.