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

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.