Hilar cholangiocarcinoma: Results of percutaneous stenting with self-expandable metal stents

Objectives: To determine the success rate of deployment and long term patency of Gianturco Rosch metal stents in inoperable hilar cholangiocarcinomas and to evaluate the effectiveness of partial drainage in the palliation of jaundice in these patients. Materials and methods: Over a period of two years, nine patients of inoperable hilar cholangiocarcinomas were referred for percutaneous biliary drainage and stent placement. All patients were put on internal external catheter drainage as a first step prior to stenting. One patient, who had severe pre-existing cholangitis, died a few days after catheter drainage. Of the remaining eight patients, seven had only partial drainage of the liver. The segments or lobe with atrophy, portal vein occlusion or tumour infiltration were excluded. The eight patients received a total of 14 Gianturco Rosch Z-stents. There were no major procedure related complications and no evidence of cholangitis up to 30 days after discharge. Bilirubin levels in all patients dropped sharply following the stenting. On follow up, 2 patients had stent occlusions at 2 months, one patient at 6.5 months and another, as a terminal event, at 11 months. Median stent patency in our series was 6.5 months. One patient had a 11-month survival without stent occlusion. Cholangitis episodes on follow up were found to be uncommon and mild when present. Endoscopic insertion of a plastic stent through the metal stent was done in 3 patients with stent occlusion. Conclusions: Percutaneous deployment of Gianturco Rosch metal stents is safe, has a high success rate and provides adequate palliation even when few segments of the liver are not drained. Due to the relatively long survival of these patients, reinterventions may be required frequently.