Abstract
From February 1993 to September 1997, we performed expandable metallic biliary endoprosthesis (EMBE) in 19 patients with biliary stricture, aged 80 or over. The cause of biliary stricture in these patients included common bile duct cancer (n=13), pancreatic cancer (n=4), gallbladder cancer (n=1) and benign biliary stricture (n=1). All patients underwent percutaneous transhepatic cholangiodrainage (PTCD), followed by placement of expandable metallic stent (EMS) through the PTCD route. EMS included three Z stents, four Wallstents, seven Accuflex stents and five Memotherm stents. The stents were successfully implanted in 18 patients (94.7%) without any serious complication, and then 15 patients (78.9%) were discharged without external drainage tube. But any adjuvant therapy was not carried out after stenting because of their advanced age. The stent patency rate of the discharged 15 patients was 50.9% for 6 months and 10.9% for 12months, respectively. Stent obstruction occured in 6 of 15 (40%) patients, and didn't occur till death in 5 (33.3%) patients. The survival rate of the all patients was 56.7% for 6 months and 26.4% for 12 months, respectively. On the correlation between the survival time and Performance status (PS), there were 4 early dead cases in PS-3 group until 60 days after stenting. In conclusion we suggested that expandable metallic endoprosthesis without any adjuvant therapy was effective in the palliation of biliary stricture in patients of advanced age because of improved quality of their life. But careful consideration was necessary in EMBE for patients of advanced age, especially in poor PS group.
