Clinical effect of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography in treatment of unresectable malignant extrahepatic biliary obstruction

Objective To investigate the clinical effect and safety of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of malignant extrahepatic biliary obstruction.Methods A total of 40 patients with unresectable malignant extrahepatic biliary obstruction who were admitted to The Second Affiliated Hospital of Zhengzhou University from January 2010 to December 2015 were enrolled, and according to the surgical method, these patients were divided into percutaneous transhepatic cholangiodrainage (PTCD) group and ERCP group, with 20 patients in each group.The two groups were compared in terms of duration of stent patency, survival time, postoperative clinical outcome, incidence of postoperative complications, and length of postoperative hospital stay.The t-test was used for comparison of continuous data between groups, and the chi-square test or the corrected chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to compare the differences in duration of stent patency and survival time between the two groups via the log-rank test.Results Compared with the PTCD group, the ERCP group had significant increases in duration of stent patency (225.6 ± 52.5 d vs 156.3 ± 44.5 d, t = 11.45, P < 0.05) and survival time (335.6 ± 42.5 d vs 225.5 ±42.5 d, t = 10.46, P < 0.05) .Seven patients in the ERCP group and 10 in the PTCD group experienced abdominal pain after surgery, and there was a significant difference between these two groups (35.0% vs 50.0%, χ2= 9.45, P < 0.05) .Compared with the PTCD group, the ERCP group had significantly lower incidence rate of severe postoperative complications (10.0% vs 30.0%, χ2= 7.49, P < 0.05) and shorter length of hospital stay (12.4 ± 2.5 d vs 19.8 ± 4.0 d, t = 10.67, P < 0.05) .Conclusion Metal stent implantation via ERCP has a similar clinical effect to PTCD in the treatment of malignant extrahepatic biliary obstruction, while compared with PTCD, ERCP allows for longer duration of stent patency and survival time, fewer complications, and a shorter length of hospital stay.Therefore, ERCP has better clinical effect and safety in patients with malignant extrahepatic biliary obstruction.