SINGLE-SESSION ENDOSCOPIC BILATERAL Y-CONFIGURED PLACEMENT OF METAL STENTS FOR HILAR MALIGNANT BILIARY OBSTRUCTION

• Published in: Digestive endoscopy 2011-01, Vol.23 (1), p.91-96
• Main Authors: Kanno, Yoshihide, Ito, Kei, Fujita, Naotaka, Noda, Yutaka, Kobayashi, Go, Obana, Takashi, Horaguchi, Jun, Takasawa, Osamu, Kato, Yuhei, Koshita, Shinsuke, Yamashita, Yasunobu, Ogawa, Takahisa
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; bilateral endoprosthesis; bilateral metal stenting; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - surgery; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis - etiology; Cholestasis - surgery; Equipment Design; Female; hilar biliary obstruction; Humans; Male; Middle Aged; multi-stenting; partial-stent-in-stent; Stents; Y-configured
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/j.1443-1661.2010.01048.x

Background:  The aim of this study was to evaluate the efficacy and safety of endoscopic bilateral biliary metal stent placement for hilar malignant obstruction. Patients and Methods:  Twenty patients with unresectable malignant hilar biliary obstruction who had undergone endoscopic bilateral Y‐configured biliary drainage with metal stents were enrolled as a study group (YMS group). Thirty‐seven patients who had undergone bilateral drainage with plastic stents were selected as a historical control (PS group). Two newly designed metal stents for bilateral Y‐configured placement were endoscopically deployed in a partial stent‐in‐stent manner in one session. Technical success, early complications, and stent patency were evaluated. Results:  The technical success rate in the YMS group was 100%. Mild post‐endoscopic retrograde cholangiopancreatography pancreatitis occurred in one patient in the YMS group and in two in the PS group. The success rate of biliary decompression was 95% in the YMS group and 89% in the PS group (P = 0.65). During a median follow‐up period of 7.3 months, the incidence of stent occlusion in the YMS group was significantly lower than that in the PS group (30% vs 62%, P = 0.028). Mean stent patency in the YMS group was 250 days and that in the PS group was 115 days (P = 0.0061). Risk factors for stent occlusion were bile duct cancer (P = 0.035) and the PS group (P = 0.07) by multivariate analysis. Conclusion:  Single‐session endoscopic bilateral biliary placement of newly designed metal stents for hilar malignant obstruction is safe and useful with a high technical success rate and a long patency period.