scholarly journals Factors Associated with the Technical Success of Bilateral Endoscopic Metallic Stenting with Partial Stent-In-Stent Placement in Patients with Malignant Hilar Biliary Obstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Toshihiro Fujita ◽  
Shinichi Hashimoto ◽  
Shiroh Tanoue ◽  
Kengo Tsuneyoshi ◽  
Yoshitaka Nakamura ◽  
...  
Keyword(s):  
Clinical Response ◽  
Delivery System ◽  
Biliary Obstruction ◽  
Procedure Time ◽  
Technical Success ◽  
Sems Placement ◽  
Stent Patency ◽  
Factors Associated ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction

Background. Bilateral biliary drainage decreases the risk of cholangitis, but bilateral endoscopic metallic stenting is technically challenging. Aim. We retrospectively evaluated the factors associated with successful bilateral self-expanding metal stent (SEMS) placement using the partial stent-in-stent (PSIS) method for malignant hilar biliary obstruction and also assessed the safety and efficacy of this technique. Methods. From April 2010 to February 2016, 47 consecutive patients (mean age, 73.0±8.6 years; 32 males and 15 females) underwent PSIS placement for malignant hilar biliary obstruction in our hospital. The technical success of PSIS, clinical response, and complications were investigated. Factors associated with the technical success of PSIS were assessed. Using a propensity score-matched analysis, we compared the procedure time, clinical response, complications, stent patency, and survival time in 17 matched patients treated with bilateral SEMS placement using a SEMS delivery system of <6.0 or ≥6.0 Fr. Results. The technical success rate was 77%. The clinical response rate was 91%, and the complication rate was 26%. Regarding complications, pancreatitis occurred in 5 patients (11%), cholangitis in 6 (13%), and cholecystitis in 1 (2%). A multiple logistic regression analysis identified the use of a SEMS with a delivery system<6.0 Fr as a factor associated with technical success (P=0.033; odds ratio, 10.769; 95% confidence interval, 1.205-96.212). In the 17 matched patients assigned according to the SEMS delivery system size, the procedure time was significantly shorter in those with a delivery system size<6.0 Fr than in those with ≥6.0 Fr (P<0.01). There were no significant differences in the clinical response, complication rate, stent patency, or survival time between the two groups. Conclusion. Using a delivery system<6.0 Fr in size helped improve the technical success and reduced the procedure time for the placement of a SEMS by the PSIS method.

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

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.

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

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.

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

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 Patency ◽  
Percutaneous Approach ◽  
Hilar Biliary Obstruction ◽  
Bilateral Stenting ◽  
Malignant Hilar Biliary Obstruction

Abstract PURPOSE To compare the clinical efficacy and safety between side-by-side (SBS) and stent-in-stent (SIS) deployment for malignant hilar biliary obstruction via percutaneous approach. 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 stent insertion with a SIS mode (SIS group), and the remaining 38 patients with a SBS mode (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 of the two groups. The serum bilirubin level reduced quicker at 1 week after the procedures in the SBS group compared with 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 significant longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not differ significantly between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05). CONCLUSIONS Percutaneous transhepatic bilateral stenting using either SBS or SIS techniques is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers quicker improvement of jaundice, a lower incidence of cholangitis after the procedures, and a longer stent patency period than SIS.

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

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.

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

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 595-599 ◽  
Author(s):  
Tadahisa Inoue ◽  
Mayu Ibusuki ◽  
Rena Kitano ◽  
Yuji Kobayashi ◽  
Tomohiko Ohashi ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Median Time ◽  
Biliary Obstruction ◽  
Success Rates ◽  
Metal Stent ◽  
Sems Placement ◽  
Eligibility Criteria ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction ◽  
Selection Of

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.

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

Endoscopy ◽  
2017 ◽  
Vol 49 (11) ◽  
pp. 1087-1091 ◽  
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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