Obstructive jaundice: results after percutaneous transhepatic insertion of self-expandable metallic endoprotheses

Abstract

SUMMARY
Background: Evaluation of the efficacy of the percutaneous
transhepatic insertion of metallic endoprothesis in 53 patients
with biliary obstruction.
Materials and methods: From September 1994 to December
2001, 83 patients with obstructive jaundice, 79 with malignancy
and 4 with benign obstruction, aged 29-92 years (mean
age 67,3 years), attended the Radiology Department of our
hospital. In 3 patients, the findings of percutaneous cholangiography
did not indicate any further access. 68 metallic
stents were implanted in 53 out of the 80 remaining patients,
whereas the other 27 patients were treated with percutaneous
biliary drainage: external drainage was performed
in 21 patients in order to assist a following operation,
and a combined internal-external drainage in 6 patients.
Hemobilia occured in one patient and required embolization
of the right hepatic artery. In 5 cases a new procedure
was needed because of the occlusion of the endoprotheses
after 40-278 days.
Results: Clinical improvement and decrease in serum
bilirubin levels was achieved in all patients. The survival
time in patients with malignancy ranged between 6 to 485
days (mean survival time 139 days). Obviously, the patients
who were treated with implantation of an endoprothesis had
a better quality of life in comparison to those treated only
with external or internal-external drainages and were not
subsequently operated. Conclusion: The percutaneous transhepatic insertion of
metallic stents is proved to be an efficient and secure method
of biliary obstruction treatment, particularly in malignant
inoperable cases.
Key-words: metallic endoprothesis - biliary obstruction -
percutaneous drainage