Metal stent implantation for palliation of malignant biliary obstruction-a report of 57 cases

AIMS To report the first experience in China in the treatment of malignant biliary obstruction with expand- able metal stent which allows the insertion of an endo- prosthesis as large as one cm in diameter. METHODS Between April 1994 and May 1996,we implanted expandable metal stents in 57 patients with incurable malignant biliary obstruction,among whom 54 underwent endoscopic procedure and the other 3 re- ceived percutaneous transhepatic placement. RESULTS Insertion of the stent following guidewire positioning was successful in 95% of the patients. Two patients developed cholangitis after stent insertion and were successfully treated with conservative treatment. The jaundice was eliminated completely in 21 cases and markedly decreased in 23 cases within 2 weeks af- ter placement of the stent. Nine patients,however, had late cholangitis due to stent failure after a median interval of 14 days. Twenty-three cases underwent na- sobiliary transient drainage and 3 underwent plastic stent transient drainage prior to metal stent insertion. Transient drainage was believed to have the advan- tages of drainage pre-assessment and infection controlling. CONCLUSIONS Our results show that expandable metal stent is suitable for the irresectable malignant choledochal stenosis. It can eliminate the jaundice and improve the patient's life quality. To get the highest benefit,however,the indication should be strictly selected. And to get long-term patency,the proximal and distal end of the stent proceeding the tumor should be no shorter than 2cm. In the case of hilar cancer, Bismuth classification is greatly helpful for the choice of drainage site.

Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malig- nant biliary tract diseases. Quantitative real-time re- verse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expres- sion, patient's age and serum bilirubin were each inde- pendently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in pe- ripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.