Endoscopic bilateral stent-in-stent placement For malignant hilar obstruction using a large cell type stent

• Published in: Hepatobiliary & pancreatic diseases international Vol. 15; no. 6; pp. 633 - 639
• Main Authors: Park, Jin Myung, Lee, Sang Hyub, Chung, Kwang Hyun, Jang, Dong Kee, Ryu, Ji Kon, Kim, Yong-Tae, Lee, Jae Min, Paik, Woo Hyun
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.12.2016; Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea%Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National Univer-sity College of Medicine, Jinju, Korea%Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang, Korea
• Subjects: Aged; Aged, 80 and over; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - mortality; biliary tract disease; cholangiocarcinoma; Cholangiocarcinoma - complications; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - mortality; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholestasis - diagnostic imaging; Cholestasis - etiology; Cholestasis - mortality; Cholestasis - therapy; Endocrinology & Metabolism; endoscopic biliary drainage; Female; Gallbladder Neoplasms - complications; Gallbladder Neoplasms - diagnosis; Gallbladder Neoplasms - mortality; Gastroenterology and Hepatology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Palliative Care; Prosthesis Design; Recurrence; Retrospective Studies; Risk Factors; stent insertion; Stents; Time Factors; Treatment Outcome; endoscopic biliary drainage; stent insertion; biliary tract disease; cholangiocarcinoma
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(16)60107-8

BACKGROUND： Bilateral stent-in-stent （SIS） self-expandable metal stent placement is technically chghallenging for palliation of unresectable malignant hilar obstruction. In the SIS technique, the uniform large cell type biliary stent facilitates contralateral stent deployment through the mesh of the first metallic stent. This study aimed to assess the technical success and clinical effectiveness of this technique with a uniform large cell type biliary stent. METHODS： Thirty-one patients who underwentlbilateral SIS placement using a large cell type stent were reviewed retrospectively. All patients showed malignant hilarl obstruction （Bismuth types Ⅱ, Ⅲ, Ⅳ） with different etiologies. RESULTS： Sixteen （51.6%） patients were male. The mean age of the patients was 67.0±14.0 years. Most patients were diagnosed as having hilar cholangiocarcinoma （58.1%） and gallbladder cancer （29.0%）. Technical success rate was 83.9%. Success was achieved more frequently in patients without masses obstructing the biliary confluence （MOC） than those with MOC （95.2% vs 60.0%, P=0.03）. Functional success rate was 77.4%. Complications occurred in 29.0% of the patients. These tended to occur more frequently in patients with MOC （50.0% vs 19.0%, P=0.11）. Median time to recurrent biliary obstruction was 188 days and median survival was 175 days. CONCLUSIONS： The large cell type stent can be used efficiently for bilateral SIS placement in malignant hilar obstruction. However, the risk of technical failure increases in patients with MOC, and caution is needed to prevent complications for these patients.