When used for malignant obstruction of the common duct, expandable metal stents have been shown to have longer patency rates than standard 10 French biliary endoprostheses (Lancet, 1992;340:1488). The differences in stent patency rates for hilar obstruction are less clear (GI Endosc 1993;39:310A). We postulated that similar findings would be seen when comparing 10 French and 11.5 French stents. METHODS: The study population consists of 212 patients with malignant bile duct obstruction; 46 had hilar and 166 common duct obstruction. Tumor types for the hilar group included bile duct (46%), metastatic (28%), gallbladder (13%), and other (13%). Tumor types for the common duct group included pancreatic (70%), bile duct (15%), metastatic (11%), gallbladder (1%), and other (3%). Following guidewire advancement proximal to the stricture, the patient was randomized to a 10 French or an 11.5 French biliary stent. Patients with hilar and common duct obstruction were randomized separately. Patients were prospectively- followed up every 1 to 2 months to assess for symptoms of stent occlusion and to determine the clinical response rate. Stent related interventions and hospital days resulting from stent dysfunction were tallied. The change in total bilirubin between baseline and 30 day post-stenting was compared. The groups were similar with regards to age, tumor type, tumor location, and baseline bilirubin. RESULTS: Common Duct Hilar 10F 11.5F P 10F 11.5F P (n=77) (n=81) (n=24) (n=20) Bilirubin Decrease (mg/dl) 7.5 10.1 .05 9.6 10.0 .87 Stent Survival Days 183 311 .24 115 152 .99 Patient Survival Days 142 170 .37 286 184 .86 Stent Related Hosp. Days 1.6 1.2 .45 1.6 2.9 .30 Stent Related Interventions .58 .43 .43 .92 .85 .88 SUMMARY: 1) A trend for improved patency rates was seen for the 11.5 French stent for common duct obstruction. This did not translate into a reduction in the number of stent related interventions and hospital days for stent dysfunction. 2) There was no statistical improvement in the stent patency rates for 11.5 French stents for hilar obstruction. CONCLUSION: These results suggest that larger stents may be more effective for providing longer periods of drainage in common duct obstruction. This study is ongoing.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging