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
- 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 follow-up (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.
- All Author(s)
- T. H. Lee
; D. H. Park
; S. S. Lee
; H. J. Choi
; J. K. Lee
; T. H. Kim
; J. H. Kim
; S. Jeong
; S. H. Park
; J. H. Moon
- Issued Date
- 2013
- Type
- Article
- Keyword
- Hilar bile duct obstruction; Endoscopic retrograde cholangiopancreatography; Side-by-side placement; Endoscopic revision
- ISSN
- 0163-2116
- Citation Title
- Digestive Diseases and Sciences
- Citation Volume
- 58
- Citation Number
- 2
- Citation Start Page
- 547
- Citation End Page
- 555
- Language(ISO)
- eng
- DOI
- 10.1007/s10620-012-2346-6
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/2294
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