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

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

Gastroenterology Research and Practice ◽

10.1155/2019/5928040 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

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.

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Percutaneous stenting for malignant hilar biliary obstruction: a randomized controlled trial of unilateral versus bilateral stenting

Abdominal Radiology ◽

10.1007/s00261-019-02010-6 ◽

2019 ◽

Vol 44 (8) ◽

pp. 2900-2908 ◽

Cited By ~ 6

Author(s):

Yu-Fei Fu ◽

Wen-Jie Zhou ◽

Yi-Bing Shi ◽

Wei Cao ◽

Chi Cao

Keyword(s):

Randomized Controlled Trial ◽

Biliary Obstruction ◽

Controlled Trial ◽

Randomized Controlled ◽

Hilar Biliary Obstruction ◽

Bilateral Stenting ◽

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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