Ayaru, L.; Russell, R.C.; Kurzawinski, T.R.; Hatfield, A.R.W.; Pereira, S.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA115
Academic Journal
Background: Self-expanding metal bile duct stents are excellent palliation for inoperable malignant disease. Problems may arise if metal bile duct stents are inserted before definitive histological diagnosis and staging. We aimed to determine the outcome of such patients. Methods: Retrospective case note review of patients referred to a tertiary pancreatico-biliary centre between 1994 and 2002, in whom a metal bile duct stent had been inserted endoscopically (n = 11) or percutaneously (n = 1) before definitive histological diagnosis. Results: 12 patients (5 female, 7 male; mean age 64 years, range 31-88 years) were identified in whom a metal bile duct stent had been inserted for presumed non-resectable malignant disease: (i) later found to be due to benign disease (n = 3), (ii) later found to be resectable (n = 2), (iii) before an eventual delayed confirmed malignant diagnosis (n = 4), and (iv) where the diagnosis still remains uncertain (n = 3). In group one, the median number of cholangitis episodes and plastic stent insertions were 2 (range 0-5 episodes) and 2 (range 0-4 changes), respectively, during a median follow up of 24 mo (range 12-96 mo). Tissue ingrowth into the stents was common and histologic confirmation of benign disease technically difficult. One of the patients underwent surgical bypass for recurrent cholangitis, while two patients' stents remain in situ. In group two, both patients underwent pancreatico-duodenectomy for operable ampullary carcinoma, following a delay of 4-6 mo. in group three, the median delay to diagnosis was 3 mo (range 1-24 mo). In group four, a median of 3 (range 1-5) percutaneous biopsies have been negative for malignancy, during a median follow up of 24 mo (range 6-48 mo). Conclusion: These cases indicate that metal bile duct stent insertion before definitive histological diagnosis and staging should be avoided. A small proportion of such patients will be found to have benign strictures or resectable malignant disease,...


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