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. 2019 Aug;30(8):714-721.
doi: 10.5152/tjg.2019.18317.

Percutaneous transpapillary biliary stent placement for distal malignant biliary obstruction: Outcomes and survival analysis

Qing-Quan Zu  1 , Jin-Xing Zhang  1 , Bin Wang  1 , Wei Ye  1 , Sheng Liu  1 , Hai-Bin Shi  1
Affiliations

Percutaneous transpapillary biliary stent placement for distal malignant biliary obstruction: Outcomes and survival analysis

Qing-Quan Zu et al. Turk J Gastroenterol. 2019 Aug.

Abstract

Background/aims: For distal malignant biliary obstruction (MBO), a percutaneous metal stent is usually inserted by the transpapillary method. However, stent-related complications and recurrent biliary obstruction following transpapillary stent placement are concerns, and survival analysis of patients with distal MBO has rarely been done.

Materials and methods: From January 2012 to March 2016, 104 patients underwent transpapillary uncovered metal stent placement for distal MBO at our institution. Clinical success, complications, recurrent biliary obstruction rates, and predictors of survival were analyzed.

Results: Of the total 104 patients, clinical success after stent insertion was achieved in 93 patients (90.3%). Major complications were observed in 24 patients (23.1%), which were as follows: cholangitis in 19 patients; pancreatitis in four patients; and biloma in one patient. Recurrent biliary occlusion was observed in 28 patients (26.9%). The median overall survival period was 162 days. The 3-, 6-, and 12-month overall survival rates after stent insertion were 64.4%, 41.3%, and 10.6%, respectively. Results of multivariate analysis indicated that metastatic carcinoma compared with ampullary carcinoma (HR=3.82; 95% CI, 1.30-11.24; p=0.015) and longer biliary stricture (HR=1.04; 95% CI, 1.02-1.06; p<0.001) were independent risk factors for worse survival after metal stent insertion.

Conclusion: Transpapillary stent placement was found to be effective with acceptable complication rates for treating distal MBO. Primary tumor and length of biliary stricture were found to be statistically significant independent prognostic factors for survival.

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Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of patients’ inclusion and exclusion. MBO: malignant obstructive jaundice; PTBD: percutaneous transhepatic biliary drainage; PTBS: percutaneous transhepatic biliary stent; HCC: hepatocellular carcinoma.
Figure 2
Figure 2
Cumulative overall survival rate after percutaneous transpapillary stent placement for distal malignant biliary obstruction. The median survival time was 162 days. The 3-month, 6-month, and 12-month cumulative survival rates were 64.4%, 41.3%, and 10.6%, respectively.
See this image and copyright information in PMC

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