|
|
|
| Endoscopic bilateral stent-in-stent placement for malignant hilar obstruction using a large cell type stent |
| Jin Myung Park, Sang Hyub Lee, Kwang Hyun Chung, Dong Kee Jang, Ji Kon Ryu, Yong-Tae Kim, Jae Min Lee and Woo Hyun Paik |
Seoul, Korea
Author Affiliations: Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Park JM, Lee SH, Chung KH, Jang DK, Ryu JK and Kim YT); Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea (Park JM); Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea (Lee JM); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang, Korea (Paik WH)
Corresponding Author: Sang Hyub Lee, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea (Tel: +82-2-2072-4892; Fax: +82-2-762-9662; Email: gidoctor@snuh.org) |
|
|
|
|
Abstract
BACKGROUND: Bilateral stent-in-stent (SIS) self-expandable metal stent placement is technically challenging 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 underwent bilateral SIS placement using a large cell type stent were reviewed retrospectively. All patients showed malignant hilar 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.
|
|
|
|
|
|
|
|
|
2016, Vol. 15 
