Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival

• Published in: The American journal of gastroenterology Vol. 91; no. 4; p. 654
• Main Authors: Schmassmann, A, von Gunten, E, Knuchel, J, Scheurer, U, Fehr, H F, Halter, F
• Format: Journal Article
• Language: English
• Published: United States 01.04.1996
• Subjects: Aged; Bile Duct Neoplasms - complications; Case-Control Studies; Cholestasis - etiology; Cholestasis - mortality; Cholestasis - therapy; Cost-Benefit Analysis; Equipment Design; Female; Follow-Up Studies; Gallbladder Neoplasms - complications; Humans; Male; Palliative Care - economics; Palliative Care - methods; Pancreatic Neoplasms - complications; Patient Compliance; Plastics; Retrospective Studies; Stainless Steel; Stents - economics; Survival Analysis; Time Factors
• ISSN: 0002-9270

In prospective trials in patients with malignant biliary obstruction, it has been reported that Wallstents prolong stent patency, but this does not translate into a significant survival benefit. Compared with prospective trials, however, survival may be different in clinical practice because of differences in patient compliance. We report on a retrospective, long term analysis comparing Wallstents versus plastic stents. Plastic endoprostheses (70 patients) and endoscopic Wallstents (95 patients) were placed in 165 consecutive patients with irresectable, malignant biliary obstruction in a first (1990-91) and second (1992-93) time period. Stent occlusion was treated by plastic stent placement. Patient characteristics were quite comparable in both stent groups. Initial placement of a Wallstent resulted in an increase of median stent patency of the first (10 vs 4 months, p < 0.001) and second (8 vs 3 months, p < 0.05) stent, a decrease of additional endoscopic procedures (20 vs 58%, p < 0.005), an increase of patient compliance reflected by a decrease of patients dying with untreated stent occlusion (9 vs 30%, p < 0.001), and an increase of survival time (6.5 vs 4 months, p < 0.05). Initial placement of a Wallstent results in an increase of stent patency of the first and second stent. Duration of stent patency appears to have a determinant effect on patient compliance. Increased stent patency and patient compliance seem to improve survival in clinical practice.