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Evaluation of endoscopic reintervention for self‐expandable metallic stent obstruction after stent‐in‐stent placement for malignant hilar biliary obstruction
Author(s) -
Okuno Mitsuru,
Mukai Tsuyoshi,
Iwashita Takuji,
Ichikawa Hironao,
Iwasa Yuhei,
Mita Naoki,
Yoshida Kensaku,
Iwata Keisuke,
Tomita Eiichi,
Shimizu Masahito
Publication year - 2019
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.626
Subject(s) - stent , medicine , odds ratio , self expandable metallic stent , radiology , surgery
Background Bilateral self‐expandable metallic stent ( SEMS ) placement is effective for long‐term management of unresectable malignant hilar biliary obstruction ( UMHBO ). However, endoscopic reintervention ( ERI ) for bilateral SEMS s is not well‐studied. This study aimed to evaluate ERI efficacy after stent‐in‐stent placement. Methods Data of 31 patients who underwent ERI from May 2000 to July 2018 were analyzed. Results The technical success rate was 80.7% (25/31) and no adverse events occurred. The functional success rate was 100% (25/25). In a multivariate logistic regression analysis, the angle between the bilateral SEMS s ( ABBS ) >104° (odds ratio 50.49, 95% CI 3.370–2131, P = 0.0039) and overgrowth (odds ratio 25.70, 95% CI 1.121–1234, P = 0.0423) were risk factors for ERI failure. Multiple liver metastases, which sometimes cause overgrowth, were also risk factors. After ERI , some patients underwent additional SEMS ( n = 4), plastic stent ( n = 14) placement, or internal cleaning of the initial SEMS alone ( n = 7). There were no significant intergroup differences in the 50% time to recurrent biliary obstruction. Conclusions ABBS >104° and overgrowth were risk factors for ERI failure after stent‐in‐stent placement. In the decision‐making process for initial SEMS placement for UMHBO , patient condition should be considered, including the angle between bilateral bile ducts and multiple liver metastases.