BACKGROUND: Whether uni- or bilateral drainage should be performed for malignant hilar biliary obstruction remains a matter of debate. Moreover, endoscopic placement of bilateral metallic stents has been considered difficult and complicated. Although the Y-stent with a central wide-open mesh facilitates bilateral stent placement, it has limitations. This study evaluated the feasibility and efficacy of the Niti-S large cell D-type biliary stent (LCD) with a uniform large cell for both uni- and bilateral drainage of malignant hilar biliary obstruction. METHODS: From April 2008 to March 2009, a total of 12 consecutive patients with unresectable malignant hilar biliary obstruction of Bismuth type 2 or greater underwent placement of LCD. Before LCD placement, all the patients underwent endoscopic unilateral biliary drainage using a plastic stent or a nasobiliary drainage tube. If jaundice improved after the procedure, the plastic stent or nasobiliary drainage tube was replaced with the unilateral LCD. If jaundice did not resolve or contralateral cholangitis occurred, bilateral LCD placement was performed. RESULTS: Seven patients had unilateral and five patients had bilateral LCD placement. Technical success was achieved for all 12 patients. An early complication occurred for one patient (8%), and stent occlusion occurred for six patients (50%) because of tumor ingrowth (n=4) or sludge (n=2). These patients were managed by insertion of plastic stents (n=4) or percutaneous transhepatic biliary drainage (n=2). The median stent patency period was 202 days. CONCLUSIONS: The newly designed endoscopic metallic stent may be feasible and effective for malignant hilar biliary obstruction, and endoscopic reintervention is relatively simple.
BACKGROUND: Whether uni- or bilateral drainage should be performed for malignant hilar biliary obstruction remains a matter of debate. Moreover, endoscopic placement of bilateral metallic stents has been considered difficult and complicated. Although the Y-stent with a central wide-open mesh facilitates bilateral stent placement, it has limitations. This study evaluated the feasibility and efficacy of the Niti-S large cell D-type biliary stent (LCD) with a uniform large cell for both uni- and bilateral drainage of malignant hilar biliary obstruction. METHODS: From April 2008 to March 2009, a total of 12 consecutive patients with unresectable malignant hilar biliary obstruction of Bismuth type 2 or greater underwent placement of LCD. Before LCD placement, all the patients underwent endoscopic unilateral biliary drainage using a plastic stent or a nasobiliary drainage tube. If jaundice improved after the procedure, the plastic stent or nasobiliary drainage tube was replaced with the unilateral LCD. If jaundice did not resolve or contralateral cholangitis occurred, bilateral LCD placement was performed. RESULTS: Seven patients had unilateral and five patients had bilateral LCD placement. Technical success was achieved for all 12 patients. An early complication occurred for one patient (8%), and stent occlusion occurred for six patients (50%) because of tumor ingrowth (n=4) or sludge (n=2). These patients were managed by insertion of plastic stents (n=4) or percutaneous transhepatic biliary drainage (n=2). The median stent patency period was 202 days. CONCLUSIONS: The newly designed endoscopic metallic stent may be feasible and effective for malignant hilar biliary obstruction, and endoscopic reintervention is relatively simple.
Authors: Giovanni D De Palma; Angelo Pezzullo; Maria Rega; Marcello Persico; Francesco Patrone; Luigi Mastantuono; Giovanni Persico Journal: Gastrointest Endosc Date: 2003-07 Impact factor: 9.427
Authors: Do Hyun Park; Sang Soo Lee; Jong Ho Moon; Hyun Jong Choi; Sang-Woo Cha; Jong Hyeok Kim; Dong-Wan Seo; Sung-Koo Lee; Sang-Heum Park; Moon-Sung Lee; Sun-Joo Kim; Myung-Hwan Kim Journal: Gastrointest Endosc Date: 2009-06 Impact factor: 9.427
Authors: Jung Hyun Lee; Dae Hwan Kang; Ji Young Kim; Sun Mi Lee; Do Hoon Kim; Chan Won Park; Hwal Suk Cho; Gwang Ha Kim; Tae Oh Kim; Jeong Heo; Geun Am Song; Mong Cho; Suk Kim; Chang Won Kim; Jun Woo Lee Journal: Gastrointest Endosc Date: 2007-08 Impact factor: 9.427
Authors: A A Polydorou; E M Chisholm; A A Romanos; J F Dowsett; P B Cotton; A R Hatfield; R C Russell Journal: Endoscopy Date: 1989-11 Impact factor: 10.093