Palliation of inoperable biliary obstruction with self-expanding metal endoprostheses: a review of 77 patients.

Our experience of inserting 90 self-expanding metal endoprostheses in 77 patients with obstructive jaundice is described. All were inserted percutaneously. The longest metal endoprosthesis available was inserted where possible. For local economic reasons most patients had a normal serum albumin, and no evidence of metastases at presentation. Dilatation of biliary occlusions and strictures was not performed. Six re-interventions have been necessary because of tumour ingrowth or overgrowth. Serum bilirubin levels fell to normal in 98.7% of patients within 7 days of insertion. Self-expandable metal endoprostheses offer technical, psychological, physiological and anatomical advantages compared to other forms of palliation in biliary obstructions thought to be unsuitable for surgery. Furthermore, where stents have to be placed percutaneously because endoscopy is not possible, self-expanding metal endoprostheses should be used.