Complications of Percutaneously Inserted Biliary Wallstents

Complications were assessed during and after percutaneous Wallstent endoprosthesis insertion in patients with inoperable malignant biliary obstruction. Two hundred seven Wallstents were inserted in 176 patients: 74 had hilar strictures and 102 had distal strictures. Median survival after stent placement was 95 days. Early complications occurred in 12 patients (7%), predominantly cholangitis and reobstruction. Thirty-day mortality was 12%; 2% of deaths (three patients) were procedure related. Late complications, predominantly reobstruction, occurred in 35 patients (20%). Obstruction recurred in 33 patients (19%) after a median period of 135 days; 27 had a hilar stricture. Tumor overgrowth was the major cause of reobstruction (n = 19), especially proximal overgrowth. Tumor ingrowth caused reobstruction in three patients. Other causes were rare. No reobstruction due to sludge occurred. Reintervention was performed in 25 patients. Nineteen of the 25 patients benefited from repeated intervention. The use of the Wallstent is preferable to use of a plastic stent, as the major complication—reobstruction—is not stent related predominantly but is caused by tumor progression.