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High single‐session success rate of endoscopic bilateral stent‐in‐stent placement with modified large cell N iti‐ S stents for malignant hilar biliary obstruction
Author(s) -
Kogure Hirofumi,
Isayama Hiroyuki,
Nakai Yousuke,
Tsujino Takeshi,
Matsubara Saburo,
Yashima Yoko,
Ito Yukiko,
Hamada Tsuyoshi,
Takahara Naminatsu,
Miyabayashi Koji,
Mizuno Suguru,
Mohri Dai,
Kawakubo Kazumichi,
Sasaki Takashi,
Yamamoto Natsuyo,
Hirano Kenji,
Sasahira Naoki,
Tada Minoru,
Koike Kazuhiko
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12055
Subject(s) - medicine , stent , radiology , occlusion , balloon , surgery , gallbladder cancer , metastasis , gallbladder , cancer
Background Endoscopic bilateral self‐expandable metallic stent ( SEMS ) placement in a stent‐in‐stent method for malignant hilar biliary obstruction is technically challenging. Technical difficulties in the initial placement and reinterventions for stent occlusion are disadvantages inherent to this stent‐in‐stent method. We previously reported the feasibility of N iti‐ S large cell D ‐type biliary stents ( LCD ). This multicenter prospective consecutive study evaluated the efficacy of bilateral SEMS placement using modified LCD with large and uniform cells, a slimmer delivery system and high radial force. Patients and Methods From J uly 2010 to J une 2011, 26 consecutive patients with unresectable malignant hilar biliary obstruction underwent endoscopic bilateral placement of modified LCD in a stent‐in‐stent method at three tertiary hospitals. Ten patients had gallbladder cancer, eight had cholangiocarcinoma, four had lymph node metastasis, two had intrahepatic cholangiocarcinoma, and two had liver metastasis. Results Single‐session and final technical success rate was 96% and 100%, respectively. Functional success rate was 89%. Stent occlusion occurred in 11 patients (42%) because of sludge ( n = 7) or tumor ingrowth ( n = 4). Endoscopic bilateral reintervention was technically easy and successful: six patients had stent clearance by balloon sweeping and five had plastic stent placement. According to K aplan– M eier analysis, median survival and stent patency were 220 days and 157 days, respectively. Conclusions Modified LCD achieved a high technical success rate both in the initial stent‐in‐stent placement and in bilateral reinterventions in patients with malignant hilar biliary obstruction.