From December 1993 to December 1994, we inserted 14 biliary
endoprostheses (Wallstent) endoscopically in 12 consecutive patients (5 men and 7 women; 55-91 years [mean 69.8 years] of age) with malignant biliary
stenosis. Successful placement of Wallstent was achieved in all 12 patients. Procedure related death was encountered in one patient (8.3%) who was complicated with
emphysematous cholecystitis, combined with a slipping migration of the
stent. In 11 of the 12 patients, serum
bilirubin levels reduced to less than 2.0 mg/dl. Acute obstruction, which was defined as the obstruction of the
stent within 24 hours after the
stent placement, occurred in 2 patients (16.7%). Endoscopic nasal bile drainage (ENBD) following
stent placement was performed in 4 patients and acute obstruction was not developed in these cases. After
endoprosthesis 8 patients were discharged with 6-47 hospital days and the average hospitalized period excluding a case with
cerebral infarction was 12.7 days. Excluding one procedure related death, 6 patients died of primary
malignancy 39-189 days (average 90.7 days) after
endoprosthesis and in 2 cases recurrence of
jaundice was observed. The other 4 patients have been alive for 60-174 days (average 102.5 days) without
jaundice. The survival rate of the all patients was 64% for 3 months and 32% for 6 months, respectively. In conclusion, we suggested that the endoscopic Wallstent placement would contribute to the improvement of the quality of life for patients with malignant biliary
stenosis. However, acute obstruction may be developed in some cases. For the purpose of managing acute obstruction, we recommend ENBD for a few days following the placement of a Wallstent.