Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center

BackgroundA significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management.ObjectiveOur purpose was to review the management and outcomes of patients with biliary SEMS occlusion.Design and SettingRetrospective chart review at a single tertiary care hospital.PatientsFrom January 1999 to October 2005, a total of 90 patients had SEMSs placed for malignant biliary obstruction, and 27 of these occluded.Main Outcome MeasurementsTechnical success of treating SEMS occlusion, stent patency and need for reintervention, and incremental cost analysis.ResultsA total of 60 ERCPs were performed to treat SEMS occlusions in 27 patients. The success rate was 95%; however, 52% of patients eventually required more than 1 intervention. Placing a second SEMS through the existing SEMS (n = 14) provided the lowest reocclusion rate (43% vs 55% and 100%), the longest time to reintervention (172 days vs 66 and 43 days, P = .03), and a trend toward longer survival (285 days vs 188 and 194 days) compared with plastic stent and mechanical balloon cleaning, respectively. Incremental cost analysis showed both uncovered SEMSs and plastic stents to be cost effective strategies.LimitationsSmall number of patients, retrospective study.ConclusionsTreatment of biliary SEMS occlusion with SEMS insertion provides for longer patency and survival, decreases the number of subsequent ERCPs by 50% compared with plastic stents, and is cost-effective.