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

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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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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Efficacy and Long-Term Outcomes of Side-by-Side Self-Expandable Metal Stent Placement Using a 2-Channel Endoscope for Unresectable Malignant Hilar Biliary Obstruction Occurring After Billroth II Reconstruction (with Video)

Digestive Diseases and Sciences ◽

10.1007/s10620-018-5013-8 ◽

2018 ◽

Vol 63 (6) ◽

pp. 1641-1646 ◽

Cited By ~ 1

Author(s):

Kosuke Okuwaki ◽

Hiroshi Yamauchi ◽

Mitsuhiro Kida ◽

Hiroshi Imaizumi ◽

Tomohisa Iwai ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Metal Stent ◽

Long Term Outcomes ◽

Billroth Ii ◽

Billroth Ii Reconstruction ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

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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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Faculty Opinions recommendation of Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: prospective long-term study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718075894.793482188 ◽

2013 ◽

Author(s):

Steve Pereira

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Metal Stent ◽

Term Study ◽

Long Term Study ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

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T1527: Y-Shaped Endoscopic Bilateral Metal Stent Placement for Malignant Hilar Biliary Obstruction: Efficacy of a Biliary Y-Stent

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.03.740 ◽

2010 ◽

Vol 71 (5) ◽

pp. AB300-AB301

Author(s):

Jin Hong Kim ◽

Jae Chul Hwang ◽

Yoonchul Lee ◽

Sun Gyo Lim ◽

Byung Moo Yoo

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Metal Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

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Novel 7-mm-diameter double bare metal stent for endoscopic side-by-side stent placement in malignant hilar biliary obstruction

VideoGIE ◽

10.1016/j.vgie.2020.01.011 ◽

2020 ◽

Vol 5 (5) ◽

pp. 201-202

Author(s):

Satoshi Asai ◽

Kotaro Takeshita ◽

Takumi Ichinona ◽

Eisuke Akamine ◽

Naoki Fujimoto

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Bare Metal Stent ◽

Bare Metal ◽

Metal Stent ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

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Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Acta Radiologica ◽

10.1177/0284185120978512 ◽

2020 ◽

pp. 028418512097851

Author(s):

Gun Ha Kim ◽

Dong Il Gwon ◽

Gi-Young Ko ◽

Jin Hyoung Kim ◽

Jong Woo Kim ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Patient Survival ◽

Large Cell ◽

Internal Drainage ◽

Cell Type ◽

Stent Patency ◽

Tumor Ingrowth ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction

Background To overcome the technical difficulty of bilateral stent-in-stent placement, large cell-type biliary stents have been developed. However, most of the studies using large cell-type stents were conducted with endoscopic method. Purpose To evaluate the efficacy and safety of percutaneous stent placement with a stent-in-stent method using large cell-type stents in patients with malignant hilar biliary obstruction. Material and Methods From December 2015 and October 2018, 51 patients with malignant hilar biliary obstruction were retrospectively studied. All of the patients underwent bilateral (n=46) or unilateral (n=5) stenting in a T, Y, or X configuration with a stent-in-stent method using large cell-type stents. Technical success, complications, successful internal drainage, stent patency, and patient survival were analyzed. Results A total of 118 stents were successfully placed in 51 patients (100.0%). Three patients had minor complications with self-limiting hemobilia. Major complications were not observed in any patient. Successful internal drainage was achieved in 45 patients (88.2%). Clinical follow-up information until death or the end of the study was available for 50 of 51 patients. The median patient survival was 285.5 days (95% confidence interval [CI] 197–374). Stent dysfunction occurred in 16 patients (35.6%) due to tumor ingrowth (n=9) or tumor ingrowth combined with biliary sludge (n=7) among the patients who achieved successful internal drainage. Median stent patency was 179 days (95% CI 104–271). Conclusion Percutaneous stent-in-stent placement with large cell-type stents is technically feasible and safe, and can be an effective technique in patients with malignant hilar biliary obstruction.

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