Abstract :
Background: Biliary drainage is a cornerstone in the management of inoperable malignant biliary tract
obstruction. Although self-expandable metallic stent (SEMS) was accepted for better patency, but it costs much
higher, whereas some patients may have comparable drainage with plastic stent. This concept leads us to conduct
a retrospective study to define patients who will be appropriate for plastic stent insertion.
Methods: Eighty-eight patients with inoperable malignant biliary tract obstruction were included. Clinical
data, laboratory results, and survival times were evaluated and compared.
Results: Seventy-two patients (81.82%) had cholangiocarcinoma (CCA), 16 cases (18.18%) had biliary
tract obstruction from metastatic tumor. Single 7 Fr plastic stents were inserted in 32 cases (36.36%) and 10 Fr
stents in 52 cases (59.09%). Patients younger than 70 years had better median survival than the older (77 vs 33
days, p <0.001). At the end of 2 weeks, patients whose total bilirubin level decreased to <50% of initial had better
median survival (78 days) than those who did not (50 days) (p = 0.011). Although, 10 Fr stent insertion could
achieve this level better than 7 Fr stent (51.43% vs 22.73%, p = 0.024), the survival times were not different. The
30-day mortality was higher in patients with Bismuth type II-IV (41.67%) and pancreatic cancer (57.14%) than in
patients with Bismuth type I and distal CCA (17.30%) (p = 0.014), but overall survival was not different. Baseline
total bilirubin had no effect on survival.
Conclusions: Median survival was longer in patients younger than 70 years, patients with Bismuth
type I and distal CCA, and those whose total bilirubin level decreased to <50% of initial level after two weeks.
Thirty-day mortality was higher in patients with Bismuth type II-IV and pancreatic cancer. Therefore, proper
selection of patients may improve the outcome of plastic stent in patients with inoperable malignant biliary tract
obstruction.
Key words : Cholangiocarcinoma (CCC), ERCP, biliary plastic stents |
file/Thai-Journal-of-gastroenterology-vol-11-no-2-3213230.pdf