Endoscopic four-branched stent-in-stent deployment of self-expandable metal stents in malignant hilar biliary obstruction

Abstract Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.

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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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Plastic Endoprostheses versus Metal Stents in the Palliative Treatment of Malignant Hilar Biliary Obstruction. A Prospective and Randomized Trial

Endoscopy ◽

10.1055/s-2007-1010295 ◽

1993 ◽

Vol 25 (03) ◽

pp. 213-218 ◽

Cited By ~ 219

Author(s):

H. J. Wagner ◽

K. Knyrim ◽

N. Vakil ◽

K. J. Klose

Keyword(s):

Randomized Trial ◽

Biliary Obstruction ◽

Palliative Treatment ◽

Metal Stents ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

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Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique

10.21203/rs.2.24611/v3 ◽

2020 ◽

Author(s):

Wei-zhong Zhou ◽

Sheng Liu ◽

Zheng-Qiang Yang ◽

Yu-Tao Xian ◽

Hong-Dou Xu ◽

...

Keyword(s):

Overall Survival ◽

Biliary Obstruction ◽

Serum Bilirubin Level ◽

Stent Insertion ◽

Technical Success ◽

Stent Deployment ◽

Stent Patency ◽

Hilar Biliary Obstruction ◽

Bilateral Stenting ◽

Malignant Hilar Biliary Obstruction

Abstract Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.

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