Efficacy and safety of SEMS insertion for palliation of nonresectable malignant biliary strictures: analyses of 94 consecutive cases

Background: Endoscopic placement of self-expandable metal stents (SEMS) has proved to be the first line treatment option for palliation of patients (pts) with symptomatic cholestasis due to biliary strictures caused by nonresectable pancreato-biliary malignancies. However, at this date, there are small number of large-scale studies analyzing the safety and efficacy of placement of SEMS for palliation of malignant biliary strictures. The aim of this study was to evaluate retrospectively the long term technical and patient-related outcomes of cases where SEMS were used for management of malignant biliary strictures.

Patients and methods: Based on our endoscopic database, 94 pts were identified who had been treated by SEMS insertion because of symptomatic malignant biliary strictures (study period: 12.2003–01.2005). The outcomes analyzed were the following: 1. technical success, 2. short- and long-term complications, 3. patient survival, 4. stent patency.

Results: During this 2-ys period, 94 pts (mean age=70 [32–94] ys, m/f=34/60) were treated with malignant biliary strictures by using SEMS. The underlying pathology was pancreatic cancer (n=43 45.7%]), hilar cholangiocarcinoma (n=21 [22.4%]), gallbladder cancer (n=14 [14.8%]), hilar metastasis (n=9 [9.6%]), choledocheal cancer (n=7 [7.5%]). At initial endoscopy, stent placement was technically successful in all, but three cases. Anatomic deformities as Billroth II gastrectomy, and pyloric stenosis required additional endoscopic sessions and balloon dilation for the latter. In 1 case, malposition of the SEMS needed removal and replacement another one. In 32 of pts (34%), insertion of SEMS was preceded by plastic stent insertion for a mean duration of 5 weeks.

Conclusions: Our data give further supports of the opinion that insertion of SEMS for palliation of pts with malignant biliary strictures is a safe and effective method.