ORIGINAL ARTICLE Metallic or Plastic Stent for Bile Duct Obstruction in Ampullary Cancer? Su Bum Park • Hyung Wook Kim • Dae Hwan Kang • Cheol Woong Choi • Je Ho Ryu • Chong Woo Chu • Soo Yong Lee • Young Il Jeong • Hye Ju Yeo • Eun Jung Kim Received: 4 May 2011 / Accepted: 2 September 2011 / Published online: 23 September 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Background and Aims Although ampullary cancer is a relatively uncommon malignancy, it is frequently associ- ated with biliary obstruction. Endoscopic biliary drainage is regarded as a palliative treatment of choice for patients with inoperable ampullary cancer. However, there are no data concerning choice of stent in this patient population. The objective of this study was to compare the efficacy of metallic and plastic stents for biliary obstruction in patients with ampullary cancer. Methods Thirty-seven patients (15 men and 22 women; median age 74.7 years) with ampullary cancer treated with endoscopic biliary drainage were enrolled. Metallic and two plastic stents were placed in 17 and 20 patients, respectively. Clinical success, stent patency, and stent malfunction were evaluated. Results Clinical success was achieved in all patients (100%). The median period of stent patency was 132.7 days in the metallic stent group and 128.5 days in the plastic stent group (P [ 0.05). Stent malfunctions developed in 17 and 19 patients in the metallic and plastic stent groups, respectively. Stent occlusion occurred in 15 (88.2%) and 15 (75%) patients and stent migration occur- red in two (11.8%) and four (20%) patients in the metallic and plastic stent groups, respectively. Conclusions Endoscopic biliary drainage using metallic or plastic stents is effective for initial endoscopic palliation in patients with obstructive jaundice because of ampullary cancer. Although metallic and plastic stents had similar clinical effect, it seems reasonable to choose two plastic stents as the first option in patients with ampullary cancer considering the cost-effectiveness. Keywords Ampullary cancer Á Stent Á Biliary obstruction Introduction Ampullary cancer is defined as a malignant tumor arising within the ampullary complex distal to the bifurcation of the common bile duct and the pancreatic duct. It is a rel- atively uncommon malignancy with an incidence of less than one per 100,000 and accounts for approximately 0.2% of all gastrointestinal tumors [1–4]. The most common symptom of ampullary cancer is jaundice; it also causes cholangitis and epigastric pain [5]. Ampullary cancer has a better prognosis than cancers of the pancreas or bile duct, with five-year survival of 45% [6–8]. The favorable prognosis of ampullary cancer is Su Bum Park and Hyung Wook Kim contributed equally to this work. S. B. Park Á H. W. Kim Á D. H. Kang (&) Á C. W. Choi Á S. Y. Lee Á H. J. Yeo Á E. J. Kim Department of Internal Medicine, School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan Medical Centers, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, South Korea e-mail: sulsulpul@yahoo.co.kr J. H. Ryu Á C. W. Chu Department of General Surgery, School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan Medical Centers, Yangsan, Korea Y. I. Jeong Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan Medical Centers, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, South Korea 123 Dig Dis Sci (2012) 57:786–790 DOI 10.1007/s10620-011-1909-2