Jae Min Lee1, Sang Hyub Lee2, Dong Kee Jang3, Kwang Hyun Chung3, Jin Myung Park4, Woo Hyun Paik5, Jun Kyu Lee6, Ji Kon Ryu3, Yong-Tae Kim3. 1. Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. 2. Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. 3. Departments of Internal Medicine and Liver Research Institute, Seoul, Korea. 4. Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea. 5. Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 6. Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
Abstract
BACKGROUND: Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. METHODS: This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. RESULTS: There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. CONCLUSIONS: Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction.
BACKGROUND: Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. METHODS: This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. RESULTS: There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. CONCLUSIONS: Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction.
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: J Figueras; L Lladó-Garriga; C Lama; J Pujol-Ràfols; M Navarro; M Martínez-Villacampa; J Domínguez; C Sancho; A Rafecas; J Fabregat; J Torras; E Ramos; X Xiol; C Baliellas; T Casanovas; E Jaurrieta Journal: Gastroenterol Hepatol Date: 1998-05 Impact factor: 2.102