The percutaneous use of the Wallstent endoprosthesis in malignant biliary obstruction

The aim of this work is to evaluate the efficacy of the percutaneously inserted metallic self-expandable Wallstent endoprosthesis in malignant biliary obstruction. Six years of experience with the Wallstent and the results of randomized trials justify an evaluation of the current status of the biliary Wallstent endoprosthesis. The problems encountered with conventional plastic endoprostheses in the palliative treatment of malignant obstructive jaundice are discussed first (Chapter 2). The major problem with plastic stents is reduced patency caused by stent blockage. Possible solutions to prolong patency. which predominantly concern minor changes in stent diameter and stent material, are described. A landmark was the introduction of the expandable metal stent in the second half of the 1980s. The revolutionary design of the metal stent was promising and a more fundamental and improved progress in stent patency was anticipated. Most experience with metal stents in malignant biliary obstruction concerns the Wallstent endoprosthesis. The clinical results with the Wallstent are the subject of this thesis. The early experiences are reported first (Chapter 3). The results of the Wallstent in hilar and distal strictures are subsequently described separately, as these involve different study populations (Chapters 4 and 5). Complications related to the use of the Wallstent are discussed, with emphasis on technical aspects of the use of the Wallstent in percutaneous stenting (Chapter 6). Finally, the place of the Wallstent in the treatment of malignant biliary obstruction will be defined (Chapter 7) and the important issues of this work are summarized.

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