Predictive factors for secondary biliary obstruction after covered stent placement in patients with malignant gastroduodenal obstruction

To evaluate predictive factors for secondary biliary obstruction after gastroduodenal stent placement when the stent covered second portion of the duodenum.

Materials and Methods:

From August 2008 to April 2024, 263 consecutive patients (179 men and 84 women; mean age, 62 years) with malignant gastroduodenal obstruction underwent fluoroscopic guided gastroduodenal stent placement. Among them 46 stent insertions were covered second portion of the duodenum. Except for eight patients who had jaundice prior to the procedure, 38 patients were enrolled in this study. We evaluated pre- and post-procedural serum bilirubin level. We defined secondary biliary obstruction as elevation of serum bilirubin level more than 3 mg/dl, with symptoms of jaundice. Stent related secondary biliary obstruction was defined as the biliary obstruction occurred within 7 days after the procedure. Logistic regression analysis was used to identify risk factors (age, sex, type of cancer, length and diameter of the stent, initial serum bilirubin level, initial CBD diameter, and ampulla of Vater involvement) associated with secondary biliary obstruction.

Results:

Stent placement was technically successful in all patients (100%). During the mean follow-up of 119 days (range, 11-1233 days), secondary biliary obstruction after gastroduodenal stent placement were occurred in 17 patients (44.7%). The mean duration from stent placement to secondary biliary obstruction was 96 days (range, 1-1070 days). In five patients (13.2%), secondary biliary obstruction was stent related (range, 1-4; mean, 3days). Seven patients underwent PTBD insertion for the treatment of secondary biliary obstruction. The other ten patients underwent conservative treatment. In logistic regression analysis, length of the stent (odds ratio, 1.586; 95% CI, 1.007-2.497; p = 0.047) was the only independent predictive factor for secondary biliary obstruction.

Conclusion:

Secondary biliary obstruction seems to be common complication of gastroduodenal stent placement when the stent covered second portion of the duodenum. The only risk factor of secondary biliary obstruction was the length of the stent.