Premium
Risk factors for technical failure of endoscopic double self‐expandable metallic stent placement by partial stent‐in‐stent method
Author(s) -
Kawakubo Kazumichi,
Kawakami Hiroshi,
Toyokawa Yoshihide,
Otani Koichi,
Kuwatani Masaki,
Abe Yoko,
Kawahata Shuhei,
Kubo Kimitoshi,
Kubota Yoshimasa,
Sakamoto Naoya
Publication year - 2015
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.170
Subject(s) - stent , medicine , odds ratio , surgery , univariate analysis , confidence interval , risk factor , radiology , multivariate analysis
Background Endoscopic double self‐expandable metallic stent ( SEMS ) placement by the partial stent‐in‐stent ( PSIS ) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction ( MHBO ). Methods Between D ecember 2009 and M ay 2013, 50 consecutive patients with MHBO underwent endoscopic double SEMS placement by the PSIS method. We retrospectively evaluated the rate of successful double SEMS placement and identified the risk factors for technical failure. Results The technical success rate for double SEMS placement was 82.0% (95% confidence interval [ CI ]: 69.2–90.2). On univariate analysis, the rate of technical failure was high in patients with metastatic disease and unilateral placement. Multivariate analysis revealed that metastatic disease was a significant risk factor for technical failure (odds ratio: 9.63, 95% CI : 1.11–105.5). The subgroup analysis after double guidewire insertion showed that the rate of technical success was higher in the laser‐cut type SEMS with a large mesh and thick delivery system than in the braided type SEMS with a small mesh and thick delivery system. Conclusions Metastatic disease was a significant risk factor for technical failure of double SEMS placement for unresectable MHBO . The laser‐cut type SEMS with a large mesh and thin delivery system might be preferable for the PSIS procedure.