Acute Biliary Obstruction After Gastroduodenal Covered Self-Expanding Metallic Stent Placement in Patients with Previous Biliary Stent Placement for Periampullary Cancer: Frequency and Protective Factors

Kun Yung Kim, Jiaywei Tsauo, Pyeong Hwa Kim, Jung Hoon Park, Zhe Wang, Min Tae Kim, Ho Young Song

Research output: Contribution to journalArticle

Abstract

Purpose: We aimed to evaluate the frequency and protective factors of acute biliary obstruction in patients with biliary stent placement followed by gastroduodenal covered self-expandable metallic stent (SEMS) placement owing to progression of periampullary cancer. Materials and Methods: We retrospectively reviewed 58 patients. Total bilirubin and alkaline phosphatase (ALP) levels before and after gastroduodenal covered SEMS placement were evaluated. The incidence of acute biliary obstruction correlated to age, sex, biliary stent length and type, and longitudinal and axial locations of the lower end of the biliary stent was evaluated. Results: Postprocedural total bilirubin and ALP levels were significantly higher than preprocedural levels (2.30 ± 2.53 vs. 1.53 ± 1.48 mg/dL; P = 0.008, 331.0 ± 248.8 vs. 258.4 ± 195.2 IU/L; P = 0.008, respectively). The increase in bilirubin levels was not statistically significant in female patients or patients with a biliary stent length ≥ 6 cm or longitudinal location of the lower end of the biliary stent distal to the lower end of the gastroduodenal stent (P CloseSPigtSPi 0.05). Seven patients (12.1%) developed acute biliary obstruction. No patients with the lower end of the biliary stent located distal to the lower end of the gastroduodenal stent developed acute biliary obstruction (P = 0.012). Conclusion: The incidence of acute biliary obstruction was 12.1% among patients with biliary stent placement followed by gastroduodenal covered SEMS placement. Longitudinal location of the lower end of the biliary stent distal to the lower end of the gastroduodenal stent was a protective factor.

Original languageEnglish (US)
Pages (from-to)603-609
Number of pages7
JournalCardiovascular and Interventional Radiology
Volume41
Issue number4
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Keywords

  • Bile ducts
  • Duodenum
  • Stent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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