Abstract
Endoscopic insertion of biliary stents is the preferred method of palliation for inoperable
malignant biliary obstruction; however, migration and clogging are frequent problems
with conventional endoprostheses. We sought to determine if expandable metal stents
offer improved palliation compared to conventional stents. Sixty-two patients with
common bile duct lesions were randomized to receive polyethylene or metal stents.
Stents were placed endoscopically or by the combined percutaneousendoscopic route.
Early results (< 1 month) were similar in both groups. Long-term follow-up (n = 28
polyethylene, median: 5 months; n = 27 metal, median: 5 months) showed a higher stent
failure rate in the polyethylene (n = 12; 43 %) compared to the metal group (n= 6;
22 %). The incidence of cholangitis was significantly higher (p < 0.05) in the polyethylene
(n = 10; 36 %) compared to the metal group (n = 4; 15 %). Life-table analysis showed
a significantly reduced incidence of sten failure (p = 0.0035) in the metal stent
compared to the polyethylene group. The total duration of hospital stay for treatment
of stent related problems was significantly higher in the polyethylene (11.8 ± 3 days)
compared to the metal group (4 ± 1.9 days; p = 0.02). The costs for retreatment because
of stent failure were significantly higher in the plastic (DM 5900 ± 1516) compared
to the metal group (DM 2070 ± 977). As a result, the overall costs (treatment of stent
related complications & stents) were higher in the polyethylene group (DM 6000 ± 1500).
Expandable metal stents offer cost effective palliation of distal malignant biliary
obstruction with fewer complications, reduced re-intervention rates and decreased
hospital stays for stent-related problems.
