Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: A prospective multicenter observational cohort study

David G. Perdue, Martin L. Freeman, James A. Disario, Douglas B. Nelson, M. Brian Fennerty, John G. Lee, Carol S. Overby, Michael E. Ryan, Gary S. Bochna, Harry W. Snady, Joseph P. Moore

Research output: Contribution to journalArticle

124 Scopus citations

Abstract

Background: There are few comparative data as to whether plastic or self-expanding metallic stents are preferable for palliating malignant hilar biliary obstruction. Methods: Thirty-day outcomes of consecutive endoscopic retrograde cholangiopancreatographies performed for malignant hilar obstruction at 6 private and 5 university centers were assessed prospectively. Results: Patients receiving plastic (N=28) and metallic stents (N=34) were similar except that metallic stent recipients more often had: Bismuth III or IV tumors (16/34 vs. 5/28 P=0.043), higher Charlson comorbidity scores (P=0.003), metastatic disease (P=0.006), and management at academic centers (P=0.018). The groups had similar rates of bilateral stent placement (4/28 vs. 5/34), and similar frequency of opacified but undrained segmental ducts (7/28 vs. 5/34). Adverse outcomes including cholangitis, stent occlusion, migration, perforation, and/or the need for unplanned endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography occurred in 11/28 (39.3%) patients with plastic versus 4/34 (11.8%) with metal stents (P=0.017). By logistic regression, factors associated with adverse outcomes included plastic stent placement (odds ratio 6.32; 95% confidence interval 1.23, 32.56) and serum bilirubin (1.11/mg/dL above normal: 1.01, 1.22) but not center type or Bismuth class. Conclusions: Metallic stent performance was superior to plastic for hilar tumor palliation with respect to short-term outcomes, independent of disease severity, Bismuth class, or drainage quality.

Original languageEnglish (US)
Pages (from-to)1040-1046
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume42
Issue number9
DOIs
StatePublished - Oct 1 2008

Keywords

  • Bile duct neoplasms
  • Bile ducts
  • Cholangiopancreatography
  • Cholestasis
  • Common bile duct neoplasms
  • Endoscopic retrograde
  • Intrahepatic
  • Klatskin tumor
  • Multicenter studies
  • Palliative care
  • Pancreatic neoplasms
  • Self-expanding metallic stents
  • Stents

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Perdue, D. G., Freeman, M. L., Disario, J. A., Nelson, D. B., Fennerty, M. B., Lee, J. G., Overby, C. S., Ryan, M. E., Bochna, G. S., Snady, H. W., & Moore, J. P. (2008). Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: A prospective multicenter observational cohort study. Journal of Clinical Gastroenterology, 42(9), 1040-1046. https://doi.org/10.1097/MCG.0b013e31815853e0