Foong Wong MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Percutaneous metallic stenting of the biliary tree is an established method of palliation in patients with biliary obstruction secondary to malignancy. Herein, we assess the efficacy and safety of percutaneous stents and try to ascertain factors that predict poorer outcome. Methods and Materials: Between May 2001 and December 2002, 90 stents were inserted in 76 patients [40 males, mean age 69.1 years, range 43-94 years]. Causes of obstruction were pancreatic cancer in 42, cholangiocarcinoma in 9, ampullary cancer in 5, metastatic cancers in 13 and others in 7. The position of the stricture was in distal common bile duct [CBD] in 45, mid CBD in 20 and hilum in 10 cases. One stent was across an anastomosis following Whipple's pancreatoduodenectomy. 14 patients had external drainage prior to definitive stenting. 54 Placehit WallstentsTM [Boston Scientific, Bulach, Switzerland] were used in 46 patients, 30 LuminexxTM [Angiomed, Medizintechnik, Germany] stents were used in 26 patients while 4 patients had other types of stents inserted. 13 patients had multiple stents of which 4 were bilobar. 37 patients had metastases at the time of stenting. Serum bilirubin, albumin and creatinine were recorded and statistical analysis performed to assess whether they were associated with early [30 day] mortality. Results: Stent insertion was successful in all cases. The mean serum bilirubin fell from 14 mg/dl to 9.7 mg/dl 3 days post procedure. Mean survival following stenting was 160 days (range 5-656 days) with 17 patients alive at the time of reporting. The 30 day mortality was 14/76 [18%] of which none had any procedure related complications. High serum bilirubin, creatinine and a low albumin were independent predictors of increased 30 day mortality [p< 0.01 or less] while presence of metastasis was not. Complications were noted in 9/76 [11.8%] patients and comprised of subphrenic collection (n=4), cholangitis (n=3), duodenal erosion (n=1) and asymptomatic biliary venous fistula (n=1). Mean primary stent patency was 140 days. 14 stents were blocked during follow up 3 of which had post procedure cholangitis. Conclusion: Percutaneous metallic stenting is an effective procedure for the palliation of malignant biliary obstruction. A high initial serum bilirubin, creatinine and a low albumin levels are independent predictors of a poorer survival outcome       Questions about this event email: fwong71@hotmail.com

Wong MD, F, Factors Influencing Outcome in Percutaneous Metallic Stenting for Malignant Biliary Obstruction.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3102531.html