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Biliary endoprosthesis dysfunction in patients with malignant hilar tumors: successful treatment by percutaneous replacement of the stent.

Symptoms caused by malignant hilar bile duct tumors are often palliated by the insertion of a percutaneous biliary endoprosthesis. However, these often occlude early and may be difficult to replace. We have reviewed our experience with percutaneous replacement of endoprostheses in 17 patients with 31 episodes of stent dysfunction. The stent was changed successfully in 30 of the 31 attempts. The average durations of initial and subsequent stent patencies were 28 and 20 weeks, respectively. Significant acute complications occurred in three patients, one of whom had a perihepatic abscess and two of whom had septicemia. Two patients died within 30 days of their last stent change. The one patient in whom attempted insertion of a new stent was unsuccessful had to remain on continuous external catheter drainage. The occluded or migrated endoprosthesis was successfully removed either percutaneously (55%) or endoscopically (26%) in 25 of the 31 cases. Successful removal of the stent and reinsertion after blockage or migration is possible in most patients. Our experience suggests that patients with malignant obstruction of the bile duct should not be refused an indwelling endoprosthesis just because of the frequent occurrence of early occlusion of the stent.