Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival

Am J Gastroenterol. 1996 Apr;91(4):654-9.


Objectives: In prospective trials in patients with malignant biliary obstruction, it has been reported that Wallstents prolong stent patency, but this does not translate into a significant survival benefit. Compared with prospective trials, however, survival may be different in clinical practice because of differences in patient compliance. We report on a retrospective, long term analysis comparing Wallstents versus plastic stents.

Methods: Plastic endoprostheses (70 patients) and endoscopic Wallstents (95 patients) were placed in 165 consecutive patients with irresectable, malignant biliary obstruction in a first (1990-91) and second (1992-93) time period. Stent occlusion was treated by plastic stent placement.

Results: Patient characteristics were quite comparable in both stent groups. Initial placement of a Wallstent resulted in an increase of median stent patency of the first (10 vs 4 months, p < 0.001) and second (8 vs 3 months, p < 0.05) stent, a decrease of additional endoscopic procedures (20 vs 58%, p < 0.005), an increase of patient compliance reflected by a decrease of patients dying with untreated stent occlusion (9 vs 30%, p < 0.001), and an increase of survival time (6.5 vs 4 months, p < 0.05).

Conclusions: Initial placement of a Wallstent results in an increase of stent patency of the first and second stent. Duration of stent patency appears to have a determinant effect on patient compliance. Increased stent patency and patient compliance seem to improve survival in clinical practice.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Bile Duct Neoplasms / complications
  • Case-Control Studies
  • Cholestasis / etiology
  • Cholestasis / mortality
  • Cholestasis / therapy*
  • Cost-Benefit Analysis
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Gallbladder Neoplasms / complications
  • Humans
  • Male
  • Palliative Care / economics
  • Palliative Care / methods*
  • Pancreatic Neoplasms / complications
  • Patient Compliance*
  • Plastics
  • Retrospective Studies
  • Stainless Steel
  • Stents* / economics
  • Survival Analysis
  • Time Factors


  • Plastics
  • Stainless Steel