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

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Background: The capacity and expertise for self-expanding percutaneous transhepatic metallic biliary stent (PTMBS) placement for palliative care in patients with malignant obstructive biliary diseases have recently been established at a private centre in Lagos, Nigeria. This article highlights the clinical and procedural aspects of the initial 18-month experience.

Methods: Between November 2018 and June 2020, PTMBS placement was performed on 16 patients. Data on patient demographics, chief complaints, primary diagnoses and diagnostic methods, concurrent procedures during stent placement, stent numbers, procedural complications, and postprocedural survival were collected and analysed.

Results: The cohort comprised 9 males and 7 females, with a mean age of 61 years. Presenting symptoms included eye and skin jaundice and pruritus, with Eastern Cooperative Oncology Group Performance Status scores of 0 for 2 patients, 1 for 9 patients, and 2 for 5 patients. Diagnoses included cholangiocarcinoma in 7 patients (44%) and pancreatic cancer in 5 (31%). All procedures were successful on the first attempt. Complications included 1 case each of intraoperative ileus, operative site infection, suspected cholangitis with sepsis, and death due to severe sepsis. Reintervention of the placed stent was necessary in 3 instances. Additional intraoperative procedures, such as brush biopsy and ultrasound-guided needle biopsy, were conducted for 7 patients. At the time of reporting, 5 patients (31%) remained alive at 22, 11, 8, 5, and 1 month(s) following the procedure.

Conclusions: This report validates the feasibility of advanced interventional radiology procedures like PTMBS placement in our region despite the inherent challenges.