Endoscopic metallic stenting is a safe, effective treatment for malignant biliary obstructions, but can be technically difficult when combined malignant biliary and duodenal obstructions exist. Available duodenal metallic stents feature a tight mesh unsuitable for trans papillary biliary stenting. We evaluated the feasibility and usefulness of new endoscopic procedures for endoscopic double-stent placement in managing such obstructions.
Metal stents have two advantages over the plastic stents: they do not occlude side branches because of the mesh; furthermore, because most hilar tumors are firm and scirrhous, tumor in-growth probably occurs less frequently.
An additional indication for the use of metal stents is the small group of patients who suffer rapid and repeated obstruction of plastic stents. These patients have not been well studied and presently cannot be identified at the start.
This group constitutes patients who will also benefit from a metal stent. All patients, who need a stent exchange because of clogging of a plastic stent within 1 month after insertion are good candidates for metal stent insertion.