Impact of Palliative Biliary Drainage between Metal Stents and Plastic Stents on Survival Rate in Unresectable Distal Malignant Biliary Stricture in Songklanagarind Hospital
Tanawat Pattarapuntakul MD1, Nisa Netinatsuton MD1, Jaksin Sottisuporn MD1, Teepawit Witeerungrot MD1, Bancha Ovartlarnporn MD1
Affiliation : 1 NKC institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
Background : Palliative biliary drainage was used to improve obstructive jaundice, nutritional status and quality of life,
along with the survival of unresectable distal malignant biliary stricture [DMBS] patients. Endoscopic retrograde
cholangiopancreatography [ERCP] with biliary drainage is mainstay treatment for these patients. The benefits of biliary
stent types, which are different in cost, on the survival rate and their efficacy of biliary drainage in DMBS patients, are still
questionable in countries with limited health budget.
Objective : To assess the impact of endoscopic palliative biliary drainage stents on survival rates, nutritional status, cost and
efficacy of biliary drainage for patients with DMBS.
Materials and Methods : All computerized medical records of DMBS patients, who underwent endoscopic biliary drainage
during January 2012 to December 2015 in Songklanagarind hospital were retrospectively reviewed. ERCP with biliary
drainage stents were undertaken at the discretion of the attending physicians. The overall survival time, nutritional status
(body weight), cost and efficacy of biliary drainage (level of total bilirubin) after drainage procedure between the metal stent,
plastic stent and plastic stent followed with metal stent group were compared.
Results : Sixty eight patients (45 males, mean age 63.7 years) were enrolled, 35 patients were classified into the plastic stent
group, 18 patients were classified into the metal stent group and 15 patients were classified into the plastic stent followed
with metal stent group. Demographic data, primary malignancy, tumor staging and ECOG score, initial total bilirubin and
stricture length were similar betweenthree groups. The median survival time was 5.4 months (95% confidence interval 3.2 to
8.5 months). Overall survival rate, weight reduction and the decline of bilirubin after biliary drainage, were not significantly
different between biliary stent types. The plastic stent group had the lowest cost of total ERCP and biliary drainage
procedure. The complication rates were not different between the biliary stent types.
Conclusion : Palliative biliary drainage by plastic stent in unresectable DMBS patient was similar in overall survival rate,
nutritional status, efficacy of drainage and complications compared with metal stent or plastic stents followed with metal
stent. However, the plastic stent group incurred the lowest cost of the completed procedure.
Keywords : Biliary drainage, Distal, Endoscopic retrograde cholangiopancreatography, Malignant biliary stricture, Stent
