Metallic stents for the treatment of biliary obstruction: a report of 100 cases.

The results of the first 100 patients to receive Gianturco-Rösch "Z" stents is presented along with recommendations for their use. The patient population was comprised of 57 men and 43 women, age range 17-85 years (mean 65 years). Fifty-four of the patients had benign obstruction and 46 had malignant obstruction. Of the benign lesions, 11 had sclerosing cholangitis and the remainder had postoperative strictures. Thirty-one of the malignant obstructions were secondary to cholangiocarcinoma with the majority of the others secondary to metastases from various sources. All but one had multiple systems involved. Patients with benign postoperative strictures were all initially treated with balloon angioplasty; if this failed, stents were inserted. In patients who had stents in place for greater than 1 year, the occlusion rate was 13%. The overall occlusion rate in the 43 patients was 7%. Patients with sclerosing cholangitis did less well. In those with sclerosing cholangitis secondary to intraarterial chemotherapy, the occlusion rate was 77%, and we no longer use the metallic "Z" stent in these patients. The stent was not used for malignant common duct obstruction. All patients had hilar involvement. In the patients with malignant obstruction, 17% re-obstructed prior to their death. The patients with cholangiocarcinoma did well with a mean survival time of 14 months and a re-obstruction rate of 16%. All late obstructions were secondary to tumor overgrowth either proximal or distal to the stents. We conclude that the "Z" stent is an effective form of treatment in patients with benign postoperative strictures and those with malignant obstruction involving the hilum. We do not recommend it as a replacement for conventional stents, but rather as an additional device that allows treatment of some of the more difficult causes of obstruction.