Endobiliary radiofrequency ablation combined with bilateral metal stent placement for malignant hilar biliary obstruction

Abstract Background The effectiveness of endobiliary radiofrequency ablation (RFA) is still uncertain, especially in patients with malignant hilar biliary obstruction (MHBO). We examined the efficacy of endobiliary RFA followed by bilateral self-expandable metal stent (SEMS) placement for unresectable MHBO. Methods 41 patients met the eligibility criteria for study inclusion. We evaluated the technical success, functional success, and recurrent biliary obstruction (RBO) associated with RFA with bilateral SEMS placement. Results The technical and functional success rates were both 95.1 % (39/41). The RBO rate was 38.5 % (15/39), and the median time to RBO was 230 days. Stricture length was positively correlated with time to RBO in the multivariate analysis (P = 0.03). The median time to RBO was significantly longer in patients with strictures > 15 mm in length than in those with strictures ≤ 15 mm (314 vs. 156 days; P = 0.02). Conclusions The present study showed that endobiliary RFA with bilateral SEMS placement achieved good results, but selection of patients with an appropriate stricture length may be needed to obtain a sufficient ablative effect.

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Endoscopic side-by-side uncovered self-expandable metal stent placement for malignant hilar biliary obstruction

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774519846345 ◽

2019 ◽

Vol 12 ◽

pp. 263177451984634 ◽

Cited By ~ 1

Author(s):

Katsuya Kitamura ◽

Akira Yamamiya ◽

Yu Ishii ◽

Yuta Mitsui ◽

Hitoshi Yoshida

Keyword(s):

Adverse Events ◽

Stent Placement ◽

Biliary Obstruction ◽

Arterial Embolization ◽

Metal Stents ◽

Success Rates ◽

Metal Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

Aim: To investigate outcomes of endoscopic bilateral side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents for unresectable malignant hilar biliary obstruction. Methods: We retrospectively analyzed 23 patients who underwent endoscopic biliary uncovered self-expandable metal stent placement for unresectable malignant hilar biliary obstruction between January 2015 and September 2016 at our institution. We performed endoscopic side-by-side placement across the papilla using 10-mm-diameter longer-model uncovered self-expandable metal stents. Outcomes included the technical and functional success rates, recurrent biliary obstruction rate, time to recurrent biliary obstruction, reintervention rate, and incidence of adverse events other than recurrent biliary obstruction. Results: Of the 23 patients, 10 with malignant hilar biliary obstruction underwent endoscopic side-by-side uncovered self-expandable metal stent placement across the papilla (median age, 83 years; 6 men). The locations of malignant hilar biliary obstruction were Bismuth types II ( n = 3), III ( n = 3), and IV ( n = 4). The median common bile duct diameter was 8 mm. The technical and functional success rates were 100% and 80%, respectively. Seven patients (70%) developed recurrent biliary obstruction because of stent occlusions, including early hemobilia in two patients and late tumor ingrowth in five patients. The median time to recurrent biliary obstruction was 66 (95% confidence interval: 29–483) days. Six patients (60%) required reintervention, and 1 (10%) underwent transcatheter arterial embolization for right hepatic arterial pseudoaneurysm. Early adverse events other than recurrent biliary obstruction occurred in four patients and late adverse event in one patient. Conclusion: Endoscopic side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents was technically feasible for unresectable malignant hilar biliary obstruction; however, it might be better to avoid this method for patients with malignant hilar biliary obstruction because of high recurrent biliary obstruction rate and shorter time to recurrent biliary obstruction.

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Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction

Endoscopy International Open ◽

10.1055/s-0043-117955 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1211-E1217 ◽

Cited By ~ 11

Author(s):

Katsuya Kitamura ◽

Akira Yamamiya ◽

Yu Ishii ◽

Yuta Mitsui ◽

Tomohiro Nomoto ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Success Rates ◽

Metal Stent ◽

Stent Removal ◽

Tumor Ingrowth ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

Abstract Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

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Endobiliary radiofrequency ablation for ingrowth occlusion after bilateral metal stent placement in patients with malignant hilar biliary obstruction

Endoscopy International Open ◽

10.1055/a-1396-4182 ◽

2021 ◽

Vol 09 (06) ◽

pp. E907-E908

Author(s):

Tadahisa Inoue ◽

Rena Kitano ◽

Masashi Yoneda

Keyword(s):

Radiofrequency Ablation ◽

Stent Placement ◽

Biliary Obstruction ◽

Metal Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

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Usefulness of a newly designed plastic stent for endoscopic re-intervention in patients with malignant hilar biliary obstruction

Endoscopy ◽

10.1055/s-0043-116215 ◽

2017 ◽

Vol 49 (11) ◽

pp. 1087-1091 ◽

Cited By ~ 3

Author(s):

Takeshi Tomoda ◽

Hironari Kato ◽

Hirofumi Kawamoto ◽

Shinichiro Muro ◽

Yutaka Akimoto ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Clinical Success ◽

Clinical Success Rate ◽

Success Rates ◽

Metal Stent ◽

Technical Success ◽

Plastic Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

Abstract Background and study aims We designed a new 7-Fr plastic stent for treating self-expandable metal stent (SEMS) obstruction in patients with malignant hilar biliary obstruction (MHBO) via endoscopic re-intervention with the stent-in-stent (SIS) method and evaluated its efficacy. Patients and methods A total of 33 consecutive patients who underwent endoscopic re-intervention for metal stent obstruction after multi-branched SEMS placement were enrolled. The initial SEMSs were placed in two or three biliary branches in 14 and 19 patients, respectively. We retrospectively evaluated the technical and clinical success, and adverse events. Technical success was defined as successful plastic stent placement into all target branches through the lumen of the SEMS. Results The technical success rates were 85.7 % (12/14) and 78.9 % (15/19) in patients who underwent two- or three-branched biliary drainage, respectively. The clinical success rate was 100 % in the 27 patients in whom technical success was achieved. We achieved successful plastic stent placement in more than two branches, using the new plastic stent combined with a conventional plastic stent, in 97.0 % (32/33). Conclusions This new plastic stent was technically feasible for treating stent obstruction via re-intervention with SIS methods.

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