Primary and Metastatic Malignant Obstructive Jaundice: Outcomes of Fluoroscopy-Guided Stent Placement in Unresectable Tumors

Aim This study aimed to comprehensively evaluate the clinical outcomes of self-expandable metal stent (SEMS) placement for malignant obstructive jaundice (MOJ), with a specific focus on efficacy, safety, stent patency, and complication rates in patients with either primary or metastatic malignancies. Methods We retrospectively analyzed data from 108 consecutive patients with MOJ who underwent fluoroscopy-guided SEMS placement at our institution between February 2013 and December 2024. Patients were stratified into primary (n = 53) and metastatic (n = 55) MOJ cohorts based on the etiology of biliary obstruction. Demographic, pathological, procedural, and outcome variables were collected, including technical success, clinical success, stent patency duration, reintervention rate, and procedure-related complications. Results Fluoroscopy-guided SEMS placement achieved 100% technical success in both the primary and metastatic cohorts. The overall clinical success rate was 88.9%, with 90.6% (48/53) in the primary group and 87.3% (48/55) in the metastatic group (p = 0.590). The mean stent patency duration was 112.0 ± 227.2 days in the primary group and 86.6 ± 120.1 days in the metastatic group, with no statistically significant difference (p = 0.470). Post-procedural fever or infection occurred in 15 (28.3%) patients in the primary group and 18 (32.7%) in the metastatic group, all managed conservatively with antibiotics. No major procedure-related complications (e.g., cholangitis, stent migration, severe bleeding, pancreatitis) were observed. Reintervention rates due to stent occlusion were 20.8% (11/53) in the primary group and 23.6% (13/55) in the metastatic group, respectively (p = 0.722). A significantly higher proportion of patients in the metastatic group received subsequent chemotherapy compared to the primary group (56.4% vs. 34.0%, p = 0.019), which was associated with prolonged stent patency (123.7 vs. 38.6 days, p = 0.004). Conclusions Fluoroscopy-guided SEMS placement is a safe and effective palliative intervention for both primary and metastatic MOJ. Stent performance in terms of patency and safety is independent of the underlying tumor etiology. Subsequent chemotherapy significantly improves stent patency in patients with metastatic MOJ. Therefore, a combined strategy of biliary stenting followed by systemic chemotherapy is recommended to optimize palliative outcomes in patients with metastatic disease.