Comparison between metastatic vs primary biliary tract cancer in their response to the wallstent

The treatment of choice for malignant biliary strictures is endoscopic stenting, either plastic or expandable. Data regarding the outcome after stenting for biliary strictures are limited regarding metastatic (M) vs primary (P) disease. We report our experience with 88 pts (P) and 33 pts (M) treated with the biliary Wallstent (Schneider, Minneapolis). There were 80 men, mean age 66.8 y (range 21-90). In P, the stricture was due to: pancreas 45, cholangio 16, gallbladder 17,ampulla 10. In M, the stricture was due to:colorectal 11,hepatoma 5, breast 6, lung 4, ovarian 1, gastric 2, lymphoma 2, adrenal 1, unknown 1. Index stent placement was 100% successful (4 required & second stent fur initial misplacement). Previous Rx included plastic stents in 82 (72 P, 10 M) and chemoXRT in 91 (61 P, 30 M). The mean stricture length was 2.3 cms (P) and 2.8 cms (M). The location in P was: CBD/CHD in 88; in M: CBD/CHD in 3 and CHD/IHD in 30. Nine pts (1 P, 8 M) had >1 stricture and required 2 stents. During a mean follow up of 120 days (P) and 132 days (M), overgrowth occured in 3 (1 P, 2 M), ingrowth in 10 (4 P, 6 M), cholangitis in 14 (5 P, 9M), tissue hyperplasia in 22 (10 P, 12M), migration in 1 (P), and hemobilia in 1 (M). Jaundice resolved in 81/88 pts (92%) in P and 29/33 (88%) in M (NS). Mean stent patency rate was 9.7 months (P) and 8.7 months (M) (NS). All pts with residual jaundice had metastatic liver disease. There was no mortality related to the stent. Choledochoscopy/Nd-YAG laser was required in 4 pts (4 M) for correction of hemobilia (1) or plastic stent placement (3). There are 14 surviving patients (6 P, 8 M), the rest have died of disease progression. Conclusion: the response to Wallstent among pts with P vs M biliary stricture is similar regarding resolution of jaundice, patency rate, and complication rate. Additional "invasive" therapy (choledochoscopy) may be needed more often in M. A prospective comparison to various plastic stents is under evaluation.

Duke Scholars

Author James Abbruzzese Medicine, Medical Oncology