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Biliary and pancreas posters 198–208

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P. Dunckley, A.S. Mee. Department of Gastroenterology, The Royal Berkshire Hospital, London Road, Reading, Berkshire, UK

Endoscopic placement of biliary stents across malignant strictures of the common bile duct is effective at palliating symptoms of obstruction. Standard practice is the initial insertion of a single plastic stent. Following this a minority of patients re-present with recurrent jaundice or cholangitis due to stent blockage. The decision as to which type of stent to then place can be difficult: expanding metal stents have a longer survival (mean=240 days) compared to plastic stents (mean=150 days), but are more expensive (£800 and £20 respectively). Without any clinically useful prognostic indicators for survival in these patients, a best guess approach is often used. In some patients it is possible to place a second plastic stent alongside the first.

Between 1990 and 2001 we attempted 31 double-stents in 24 patients with malignant strictures of the common bile duct. All had re-presented with jaundice/cholangitis following the initial insertion of a single plastic stent. Detailed records could not be raised on 6 of these patients. Of the remaining 18 patients (7 women, mean age 81yrs, range 75–84yrs; 11 men, mean age 73.3yrs, range 61–83yrs), 19 (76%) double-stents were successfully placed, 6 (24%) attempted double placements were unsuccessful. 4 patients required more than 1 double-stenting procedure. 16 patients had pancreatic carcinoma, 2 cholangiocarcinoma. The first single stent lasted between 7 and 189 days (mean=83.3 days) before jaundice/cholangitis recurred due to stent blockage. Subsequent double-stents lasted between 24 and 312 days (mean=127.1 days). Using each patient as their own control p<0.21 (NS).

Double-stents in this series lasted 6–7 weeks longer than single stents. The double-stents are placed in more advanced malignant strictures introducing negative bias into these figures. We feel double-stenting, in patients in whom it is technically feasible, may …

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