Technical Feasibility and Revision Efficacy of the Sequential Deployment of Endoscopic Bilateral Side-by-Side Metal Stents for Malignant Hilar Biliary Strictures: A Multicenter Prospective Study

Title
Technical Feasibility and Revision Efficacy of the Sequential Deployment of Endoscopic Bilateral Side-by-Side Metal Stents for Malignant Hilar Biliary Strictures: A Multicenter Prospective Study
Authors
정석
Keywords
Hilar bile duct obstruction Endoscopic retrograde cholangiopancreatography Side-by-side placement Endoscopic revision
Issue Date
2013
Publisher
DIGESTIVE DISEASES AND SCIENCES
Series/Report no.
DIGESTIVE DISEASES AND SCIENCES ; Vol.58 no.2 Startpage 547 Endpage 555
Abstract
Background Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent. Aim We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures. Methods Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency. Results Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during followup (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively. Conclusions The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.
URI
http://dspace.inha.ac.kr/handle/10505/31441
ISSN
0163-2116
Appears in Collections:
Medical School/College of Medicine (의학전문대학원/의과대학) > Medical Science (의학) > Journal Papers, Reports(의학 논문, 보고서)
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