Percutaneous expandable metallic stent biliary endoprostheses used in malignant and benign obstructive jaundice

Abstract

AIM: To evaluate the effects of expandable metallic stent biliary endoprostheses (EMSBE) via ultrasonographic guided percutaneous transhepatic approach on the treatment of benign and malignant obstructive jaundice.

METHODS: Thirty-eight patients with obstructive jaundice (29 males and 9 females) aged 27 to 69 years (mean 54.7 years) were studied. of them, 4 were benign and 34 malignant obstructions. Percutaneous transhepatic cholangiography (PTC) was performed under ultrasonic guidance. A catheter was introduced into the dilated bile duct via the introducer. A guide wire was inserted through the occlusive part of biliary duct after dilating with a double-lumen balloon catheter. A self-expandable metallic stent was inserted into the occlusive bile duct under fluoroscopic control.

RESULTS: The success rate of sonographic guided PTC was 100% (38/38) and the success rate of stent implantation was 86.8% (33/38). Biliary obstruction was eliminated immediately, jaundice subsided gradually and symptoms relieved after the procedure. During the 3 to 28 mo fellow-up, re-occlusion occurred in 4 malignant cases which were corrected by balloon catheter dilation and/or by stent, one patient had secondary cholangitis and fifteen died without jaundice 6-28 mo after the procedure. The others were alive with no jaundice. No severe complications or side effects were observed.

CONCLUSION: EMSBE via sonographic guided percutaneous transhepatic approach is a reliable and safe palliative therapy for malignant jaundice and an ideal nonoperative method for benign biliary obstruction. It has a definite positive impact on the quality of patient life.

Key Words: Expandable metallic stent biliary endoprosthesis; Cholestasis; Palliative treatment; Life quality