Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.69
Peer-review started: October 30, 2017
First decision: November 21, 2017
Revised: December 2, 2017
Accepted: December 12, 2017
Article in press: December 12, 2017
Published online: January 7, 2018
The related procedure of endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive diagnostic and therapeutic method for biliary and pancreatic diseases and plays a very important role. As for biliary drainage, endoscopic drainage by ERCP is considered to be noninvasive and the first choice of treatment.
To our knowledge, there are no reports that examined the safety of insertion of metallic stents in the elderly with an unresectable malignant biliary obstruction. Therefore, we studied the safety and usefulness of metallic stents for unresectable distal malignant biliary obstruction in a multicenter, collaborative, retrospective study.
This study aims to evaluate the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.
There are total 272 patients with unresectable distal malignant biliary obstruction in this study. Group A (184 patients under the age of 80) and Group B (88 subjects aged 80 years or more) were examined by the safety of metallic stent insertion, metal stent patency period, and the obstruction rate.
In Group B, patients had a significantly worse performance status, high blood pressure, cerebrovascular disease, heart disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 d (1-965); 252.000 ± 35.998 d (1-618) in Group A and 269.000 ± 47.885 d (1-965) in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 30.15% (82/272) patients; in 28.80% (53/184) patients in Group A and in 32.95% (29/88) of those in Group B, showing no significant difference between the two groups.
This study suggested that metallic stents can be safely inserted and are a useful treatment for unresectable distal malignant biliary obstruction in the elderly. It was suggested that metallic stent insertion for unresectable distal malignant biliary obstruction in the elderly can be conducted safely and with a high success rate. We should insert metallic stent in unresectable distal malignant biliary obstruction in the elderly patients for improvement of quality of life positively.
A prospective study is considered necessary in the future to further evaluate the feasibility and usefulness of metallic stent for unresectable distal malignant biliary obstruction in elderly patients.