BACKGROUND: Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent. AIM: We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures. METHODS: Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency. RESULTS: Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during follow-up (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively. CONCLUSIONS: The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.
BACKGROUND: Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent. AIM: We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures. METHODS: Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency. RESULTS: Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during follow-up (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively. CONCLUSIONS: The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.
Authors: Ramu P Raju; Sathya R Jaganmohan; William A Ross; Marta L Davila; Milind Javle; Gottumukkala S Raju; Jeffrey H Lee Journal: Dig Dis Sci Date: 2011-01-11 Impact factor: 3.199
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: John L S Cheng; Marco J Bruno; Jacques J Bergman; Erik A Rauws; Guido N Tytgat; Kees Huibregtse Journal: Gastrointest Endosc Date: 2002-07 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