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Biliary stent for malignant tumor and its complications

Friday 02nd February 2018 Back to list

Biliary stent insertion has high successful rate and reliable efficacy in releasing jaundice, and can improve the life quality of patients with malignant biliary obstruction.

The complications of stenting with ERCP are what concerned mostly in clinical application. Here we provide some experience and data for your reference of complication occurrence rate and its treatment.

 

Data got in 2007 World Chinese Journal of Gastrointestinal Endoscopy, for malignant biliary obstruction,the successful operation rate of ERCP  is 92.75%, the rate to eliminate jaundice is 96.88%.The complication rate is 7.97% .

 

The main complications of ERCP stenting are bleeding, perforation, pancreatitis, and cholangitis.

One way to lower complications is related with stent choice.

Radial force affects stent patency in dilation of stricture and maintenance of luminal patency. The chronic radial force is higher than the immediate expanding force as the metal stent is made of a shape memory metal wire.

Axial force is considered to define the conformability of stent to bile duct and has greater relationship with clinical outcomes comparing with radial force. When axial force increases, so does the compression on bile duct or cyst duct or pancreatic orifice. Clinically, this situation may cause kinking of bile duct with resultant pancreatitis or cholangitis.

 

The length of stent choice is mainly based on clinical experience.Stents with flared ends are popular “anchor design ”in recent years to prevent stent migration. Choosing stent of less axial force is another way to avoid migration.

 

Plastic stent is more economic comparing with metal stent, while around 60 days of implantation, plastic stent would be obstructed by biliary sludge. We suggest using two plastic stents for double-way drainage to raise the patency term. While metal stent has larger inner diameter and could promise with longer patency. When it is obstructed, remove the obstruction with balloon or insert another stent are proper methods to be used.

 

Bleeding and perforation are caused by repeated tubing and rude operation. Do not overuse contrast medium. Extract contrast medium before stent implantation. Pancreatitis and cholangitis should be treated by anti- inflammation and enzyme inhibitors.