Efficacy and safety of endoscopic retrograde bile duct stent placement in the palliative treatment of malignant biliary stricture

ObjectiveTo estimate the efficacy and safety of bile duct stent placement by endoscopic retrograde pancreatic angiography(ERCP) in the treatment of obstructive jaundice caused by malignant biliary stricture, and screen the predictive index of bile duct stent drainage effect.

MethodsOne hundred and six patients with unresectable malignant bile duct stricture diagnosed by ERCP were treated with bile duct sent placement.According to the purpose of analysis, the patients were divided into the malignant bile duct stricture liver hilum and distal group, malignant hepatic bile duct stricture Bismuth type Ⅰ and Ⅱ-Ⅳ group and malignant hepatic bile duct stricture Bismuth type Ⅱ-Ⅳ unilateral stent and bilateral group, malignant distal bile duct stricture plastic stent and metal stent group and effective and ineffective stent drainage group.The preoperative, intraoperative and postoperative related indicators were recorded, the preoperative and postoperative drainage effects and postoperative complications in each group were compared, and the related indicators affecting the stent drainage effects were analyzed and screened.

ResultsThe serum level of total bilirubin in 106 cases within 1 week after operation was significantly lower than that before operation(P < 0.05), and the effective drainage rate was 70.8%.The effective drainage rates in Bismuth Ⅰ group and metallic stent group were significantly higher than that in Bismuth Ⅱ-Ⅳ and plastic stent group(P < 0.05).The incidence rates of acute pancreatitis and cholangitis patients with malignant hilar bile duct stricture significantly increased compared with patients with distal bile duct stricture(P < 0.05).The preoperative serum albumin level and intraoperative congested bile volume were positively correlated with drainage effect(P < 0.05).

ConclusionsBile duct stent placement by ERCP in the treatment of malignant biliary stricture is safe and effective, but Bismuth Ⅱ-Ⅳ cases should be treated with caution because of higher risks of ineffective drainage and complications.The preoperative serum ALB level and amount of congested bile can predict the drainage efficacy.