Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients

• Published in: World journal of gastroenterology : WJG Vol. 24; no. 1; pp. 69 - 75
• Main Authors: Sakai, Yuji, Iwai, Tomohisa, Shimura, Kenji, Gon, Katsushige, Koizumi, Kazuya, Ijima, Masashi, Chiba, Kazuro, Nakatani, Seigo, Sugiyama, Harutoshi, Tsuyuguchi, Toshio, Kamisawa, Terumi, Maetani, Iruru, Kida, Mitsuhiro
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 07-01-2018
• Subjects: Age Factors; Aged; Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Endoscopic Retrograde - mortality; Cholestasis - diagnostic imaging; Cholestasis - etiology; Cholestasis - mortality; Cholestasis - therapy; Digestive System Neoplasms - complications; Digestive System Neoplasms - mortality; Drainage - adverse effects; Drainage - instrumentation; Drainage - mortality; Female; Humans; Japan; Kaplan-Meier Estimate; Male; Metals; Middle Aged; Palliative Care; Prosthesis Design; Retrospective Studies; Retrospective Study; Risk Factors; Stents; Time Factors; Treatment Outcome; Elderly patients; Malignant biliary obstruction; Metallic stent
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v24.i1.69

To study the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.
Of 272 patients with unresectable distal malignant biliary obstruction, 184 patients under the age of 80 were classified into Group A, and 88 subjects aged 80 years or more were classified into Group B. The safety of metallic stent insertion, metal stent patency period, and the obstruction rate were examined in each group.
In Group B, patients had a significantly worse performance status, high blood pressure, heart disease, cerebrovascular disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (
< 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 (1-965) d; 252.000 ± 35.998 (1-618) d in Group A and 269.000 ± 47.885 (1-965) d in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 82 of the 272 (30.15%) patients; in 53/184 (28.80%) patients in Group A and in 29/88 (32.95%) of those in Group B, showing no significant difference between the two groups. Procedural accidents due to metal stent insertion occurred in 24/272 (8.8%) patients; in 17/184 (9.2%) of patients in Group A and in 7/88 (8.0%) of those in Group B, with no significant difference between the two groups, either.
These results suggested that metallic stents can be safely inserted to treat unresectable distal malignant biliary obstruction even in elderly patients aged 80 years or more.