Endoscopic palliation in malignant distal biliary obstructions due to metastasis

Distal malignant biliary strictures (DMBD) often originate primarily from the organs in this region [primary DMBD (p-DMBD)]. However, it can also occur with tumor metastasis [metastatic DMBD (m-DMBD)]. The purpose of this study is to compare the endoscopic palliation outcomes of patients with m-DMBD to the outcomes of patients with p-DMBD. Clinical, laboratory data, endoscopic procedures, short and long-term results of endoscopic drainage, complications, and patient prognoses of m-DMBD patients who underwent ERCP due to DMBD between November 2017 and April 2023 were examined. If the procedure was performed for palliation purposes, a metal stent was inserted, whereas if it was performed as a bridge until the result of surgery or medical treatment was expected, a metal stent or two 10 fr plastic stents were inserted. In the m-DMBD group, there were 11 patients [group 1, age: 59 (20-80) years, 6 (54.5%) females], and in the p-DMBD group, there were 15 patients [group 2, age: 66 (41-83) years, 3 (20%) females]. Group 1 included metastases from colon, lung, breast, ovary, multiple myeloma, lymphoma, sarcoma, and prostate tumors, while group 2 consisted of pancreatic and Oddi tumors. In group 1, 7 (63.6%) patients received a metal stent, and 4 (36.4%) received a plastic stent, while in group 2, these numbers were 6 (40%) and 9 (60%), respectively. Post-procedure cholangitis (0% x 0%) and the need for rescue drainage (0% x 6.7%) were similar. The 'rate of decrease' in total and direct bilirubin was similar after one week (%56 x %48, p: 0.305 and %63 x %51, p: 0.217). Stent patency time (until death, the date of the study, or the need for re-drainage) was 3 (0.5-31) months in group 1 and 5.3 (0.1-17.5) months in group 2 (p: 0.919). Re-drainage was required in 4 (36.4%) patients in group 1 and 10 (66.7%) patients in group 2 (p: 0.119). Until the date of the study or patient death, the stent did not become obstructed in 7 (63.6%) patients in group 1 and 5 (33.3%) patients in group 2. Stent patency was higher in patients with metal stents compared to those with plastic stents [6 (54.5%) x 3 (20%) for group 1 and 1 (9%) x 2 (13%) for group 2]. Endoscopic palliation in m-DMBD patients has similar efficacy and side effects to p-MBD patients. Metal stents should be preferred whenever possible.