Kazunaga Ishigaki1, Tsuyoshi Hamada1, Yousuke Nakai2,3, Hiroyuki Isayama1,4, Tatsuya Sato1, Ryunosuke Hakuta1, Kei Saito1, Tomotaka Saito1, Naminatsu Takahara1, Suguru Mizuno1, Hirofumi Kogure1, Yukiko Ito5, Hiroshi Yagioka6, Saburo Matsubara6,7, Dai Akiyama8,9, Dai Mohri8, Minoru Tada1, Kazuhiko Koike1. 1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan. 2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan. ynakai-tky@umin.ac.jp. 3. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan. ynakai-tky@umin.ac.jp. 4. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. 5. Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. 6. Department of Gastroenterology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan. 7. Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. 8. Department of Gastroenterology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan. 9. Department of Gastroenterology, Kanto Central Hospital, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo, 158-8531, Japan.
Abstract
BACKGROUND: In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial. STUDY: Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS. RESULTS: A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. CONCLUSIONS: Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
BACKGROUND: In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial. STUDY: Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS. RESULTS: A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. CONCLUSIONS: Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
Authors: Jennifer Hsieh; Amar Thosani; Matthew Grunwald; Satish Nagula; Juan Carlos Bucobo; Jonathan M Buscaglia Journal: Hepatobiliary Surg Nutr Date: 2015-10 Impact factor: 7.293
Authors: Gabriel Mayo Vieira de Souza; Igor Braga Ribeiro; Mateus Pereira Funari; Diogo Turiani Hourneaux de Moura; Maria Vitória Cury Vieira Scatimburgo; João Remí de Freitas Júnior; Sergio A Sánchez-Luna; Renato Baracat; Eduardo Turiani Hourneaux de Moura; Wanderley Marques Bernardo; Eduardo Guimarães Hourneaux de Moura Journal: World J Hepatol Date: 2021-05-27