Abstract
Palliation of unresectable malignant hilar biliary stricture is controversial with respect to optimal types of stents and extent of drainage. A consecutive series of 92 patients from 13 institutions with unresectable malignant hilar biliary strictures undergoing palliative stent placements were prospectively reviewed. Extent of biliary drainage and type of stents used are: unilateral metallic stent placement in 19, unilateral plastic stent in 22, bilateral metallic stents in 21 and bilateral plastic stents in 30. Relatively small caliber stents were inserted in most patients undergoing bilateral drainage with plastic stents. Major cause of stent occlusion was: tumor ingrowth for metallic stents, and bile encrustation for plastic stents. Early and late cholangitis associated with stent occlusion was significantly frequent in patients undergoing bilateral plastic stent placement. Cholangitis was not observed in patients undergoing metallic stent placement. According to Kaplan-Meier method, bilateral metallic stents offered significantly longer patency, compared with the other three groups. There was no significant difference in the median length of survival between groups. Bilateral metallic stent placement may provide effective palliation in patients with hilar biliary strictures. Palliation with bilateral small plastic stents, due to their propensity to be easily occluded, may become less feasible.
