Self-expanding metal stents in the palliation of malignant biliary obstruction: Own experiences with 148 cases
| Autor: | János Banai, K Dunkel, F Zsigmond, K Rábai, Tibor Gyökeres, A Bördős |
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| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | Zeitschrift für Gastroenterologie. 50 |
| ISSN: | 1439-7803 0044-2771 |
| Popis: | Introduction: The diagnosis of papillary, pancreas, biliary duct and gallbladder tumors is often late and there is no chance for curative surgery. In many cases the condition of the patient render curative operation impossible. In these cases biliary metal stents are the best palliative method for resolving the jaundice of the patients. Patients and methods: In our unit between 1 January 2008 and 5 March 2012 we placed biliary metal stents in 148 patients (67 males and 81 females) suffering from inoperable malignant biliary obstruction. The median age of them was 70.67 year, in the range of 32–97 year. Of the stents 31 were covered (always following previous cholecystectomy) and 117 uncovered. The indications were the following: tumors of the head of the pancreas or tumors of the caudal pancreas extended to the pancreas-head (86), Klatskin-tumors (28), Vater-papilla malignancies (7), choledochus or gallbladder tumors (15), hepatocellular carcinoma (4), colon carcinoma metastasis (4), adenocarcinoma metastasis (1) (with unknown primer tumor), neuroendokrin tumor (1), metastasis of lung cancer (1) and in one case the diagnosis remained unclear. We used the following length of stents: 100–104mm (19), 90–92mm (7), 80mm (38), 70–74mm (36), 60–62mm (25) and 50–52mm (23). Complications were cholangitis in 9 cases, hyperamilasaemia in 17 cases, we detected 1 severe acut pancreatitis and 2 mild pancreatitis, bleeding in 1 case and acute cholecystitis in also 1 patient. 3 patients died within one week after the intervention (1 severe acut pancreatitis, 2 pulmonary embolia). During the follow-up 25 patients had reocclusion of the biliary duct because of tumor ingrowth/overgrowth. In 22 patients the repeated obstruction was managed with insertion of plastic biliary stent, in 1 case with the combination of a second biliary metal stent and percutaneous intervention, in 1 patient with PTD and in 1 patient with surgery. Conclusion: Biliary metal stent placement is a safe and effective palliative method in the management of inoperable malignant biliary obstruction, which is also tolerable for elderly patients and results in better quality of remaining life. |
| Databáze: | OpenAIRE |
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