PURPOSE: To evaluate the necessity of draining more than one hepatic duct in malignant hilar obstructions. MATERIALS AND METHODS: Two hundred seventeen self-expandable uncovered metallic stents (144 biliary Wallstents and 73 Memotherm nitinol stents) were placed percutaneously in 138 patients with unresectable malignant hilar obstructions. The patients included 76 men and 62 women, with a median age of 76 years (range, 43-82 years). Single-duct drainage was achieved in 74 patients (54%) by placing one stent (n = 59) or by placing an additional stent inserted telescopically through the first one (n = 15) to achieve an adequate stent length for long strictures (group 1). In 64 patients (46%), to maintain two-duct drainage, two stents were inserted through dual transhepatic tracts in a "Y" configuration (n = 41; group 2Y) or a single transhepatic tract in a "T" configuration (n = 23; group 2T). RESULTS: The overall technical success rate was 100%, and early clinical response was obtained in 89% of patients. The overall rate of major complications was 5.7% and did not show a statistically significant difference among groups 1, 2Y, and 2T in Bismuth type II, III, and IV obstructions. The patency rate was not statistically significant among groups 1, 2Y, and 2T in Bismuth type II and III obstructions (P >.05). However, in Bismuth type IV obstructions, the patency rate was significantly higher in group 2Y (P =.03; Kruskal-Wallis test). CONCLUSION: There is no need to place more than one stent in Bismuth type I, II, and III hilar obstructions. In Bismuth type IV obstructions, deployment of two parallel stents through dual transhepatic tracts should be performed.
PURPOSE: To evaluate the necessity of draining more than one hepatic duct in malignant hilar obstructions. MATERIALS AND METHODS: Two hundred seventeen self-expandable uncovered metallic stents (144 biliary Wallstents and 73 Memotherm nitinol stents) were placed percutaneously in 138 patients with unresectable malignant hilar obstructions. The patients included 76 men and 62 women, with a median age of 76 years (range, 43-82 years). Single-duct drainage was achieved in 74 patients (54%) by placing one stent (n = 59) or by placing an additional stent inserted telescopically through the first one (n = 15) to achieve an adequate stent length for long strictures (group 1). In 64 patients (46%), to maintain two-duct drainage, two stents were inserted through dual transhepatic tracts in a "Y" configuration (n = 41; group 2Y) or a single transhepatic tract in a "T" configuration (n = 23; group 2T). RESULTS: The overall technical success rate was 100%, and early clinical response was obtained in 89% of patients. The overall rate of major complications was 5.7% and did not show a statistically significant difference among groups 1, 2Y, and 2T in Bismuth type II, III, and IV obstructions. The patency rate was not statistically significant among groups 1, 2Y, and 2T in Bismuth type II and III obstructions (P >.05). However, in Bismuth type IV obstructions, the patency rate was significantly higher in group 2Y (P =.03; Kruskal-Wallis test). CONCLUSION: There is no need to place more than one stent in Bismuth type I, II, and III hilar obstructions. In Bismuth type IV obstructions, deployment of two parallel stents through dual transhepatic tracts should be performed.
Authors: Evan L Fogel; Safi Shahda; Kumar Sandrasegaran; John DeWitt; Jeffrey J Easler; David M Agarwal; Mackenzie Eagleson; Nicholas J Zyromski; Michael G House; Susannah Ellsworth; Ihab El Hajj; Bert H O'Neil; Attila Nakeeb; Stuart Sherman Journal: Am J Gastroenterol Date: 2017-01-31 Impact factor: 10.864
Authors: Sang Hyub Lee; Joo Kyung Park; Won Jae Yoon; Jun Kyu Lee; Ji Kon Ryu; Yong Bum Yoon; Yong-Tae Kim Journal: World J Gastroenterol Date: 2007-08-07 Impact factor: 5.742