Placement of percutaneous transhepatic metallic biliary stents for malignant causes of obstructive jaundice: A retrospective study investigating the early experiences at a private hospital in Lagos, Nigeria

Abstract

[Accepted Research Article]

Background: Recently, the capacity and expertise to place self-expanding percutaneous transhepatic metallic biliary stents (PTMBS) for the palliative care of patients with malignant, obstructive biliary diseases became available at a private center in Lagos, Nigeria. This article highlights important clinical and procedural aspects of the inaugural 18-month experience.

Method: From November 2018 till June 2020, PTMBS placement was done in 16 patients. We retrieved and analyzed data on patients’ demographics, chief complaints, primary diagnoses and mode of diagnosis, additional procedures carried out during stent placement, number of stents placed, complications of the procedure, and survival post-procedure.

Results: There were nine males and seven females in this cohort. The mean age was 61 years. At presentation, the primary complaints were yellowness of the eyes and body itching, and Eastern Cooperative Oncology Group Performance Status was 0 for two patients, 1 for nine patients, and 2 for five patients. There were seven cases of cholangiocarcinoma (44%) and five cases of pancreatic cancer (31%), among other etiologies. For all patients, the procedure was successful at the first attempt. The procedures were complicated by one case each of intraoperative ileus, operative site infection, sepsis with suspected cholangitis, and death from overwhelming sepsis. In three instances, revisiting the placed stent was necessary. Additional intra-operative procedures (brush biopsy and ultrasound-guided needle biopsy) were performed in seven cases. Five (31%) of the patients were still alive at 22, 11, 8, 5, and 1 month(s) post-procedure.

Conclusion: This report demonstrates that such a high-end and beneficial interventional radiology procedure as PTMBS placement is possible in our locality, notwithstanding the associated challenges.