Percutaneous transhepatic biliary stenting in Békés county hospital

Background: Malignant biliary obstruction is often inoperable at presentation and has a poor prognosis. Percutaneous Transhepatic Biliary stenting with endoprothesis (plastic or self-expanding metal stent) is a palliative procedure to relieve malignant biliary obstruction, when endoscopic technique was not possible or had failed. This study reports our experience of percutaneous transhepatic biliary stenting in malignant biliary obstruction.

Methods: The authors present retrospective analysis of 46 patients who had percutaneous transhepatic biliary stenting in malignant biliary obstruction, between Jan 2011 and Mar 2014 at Békés County Hospital/Gyula. The etiology included 18 (40%) cases of pancreatic cancer, 8 (17%) cases of cholangiocarcinoma, 4 (8%) cases gallblader cancer, 4 (8%) cases of ampullary carcinoma and 12 (27%) cases of other metastatic liver diseases.

Results: 46 patients (23 women, 23 men, mean age: 65 years, range: 41 – 90 years) underwent percutaneous transhepatic biliary stenting after failed endoscopic procedures. The success rate was 93% with placement of single plastic stents in 30 patients, double stents in 9 patients and self-expanding metal stents in 4 patients (one with rendezvous technique). Mean survival time was 65 days with range of 1 – 262 days in 46 patients. The survival time was higher in younger patients with no other co-morbidity. The overall complication rate was 39% (n:18), and the commonest complication was cholangitis 13% (n:6) and stent occlusion 10%(n:5). We lost two patients in the first 24 hours because of severe sepsis.

Conclusion: Our results suggest that percutaneous transhepatic biliary stenting in malignant biliary obstruction is effectively in patients who had failed endoscopic stenting, although the complication rate is high, but the survival time was longer and the patients quality of life was better.