DOI QR코드

DOI QR Code

Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

  • Kim, Jin-Hong (Department of Gastroenterology, Ajou University School of Medicine)
  • Published : 2011.12.30

Abstract

Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be more effective in >80% of cases with lower morbidity than surgery, and perhaps may provide a survival benefit. In patients with unresectable malignant hilar obstruction, the endoscopic approach for biliary drainage with biliary stent placement has also been considered as the treatment of choice. There is still a lack of clear consensus on the use of covered versus uncovered metal stents in malignant distal bile duct obstructions and plastic versus metal stents and unilateral versus bilateral drainage in malignant hilar obstructions.

Keywords

References

  1. Ahrendt SA, Nakeeb A, Pitt HA. Cholangiocarcinoma. Clin Liver Dis 2001;5:191-218. https://doi.org/10.1016/S1089-3261(05)70161-6
  2. Lazaridis KN, Gores GJ. Cholangiocarcinoma. Gastroenterology 2005; 128:1655-1667. https://doi.org/10.1053/j.gastro.2005.03.040
  3. Farley DR, Weaver AL, Nagorney DM. "Natural history" of unresected cholangiocarcinoma: patient outcome after noncurative intervention. Mayo Clin Proc 1995;70:425-429. https://doi.org/10.4065/70.5.425
  4. Berr F. Photodynamic therapy for cholangiocarcinoma. Semin Liver Dis 2004;24:177-187. https://doi.org/10.1055/s-2004-828894
  5. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998;47:354-362. https://doi.org/10.1016/S0016-5107(98)70218-4
  6. Chahal P, Baron TH. Endoscopic palliation of cholangiocarcinoma. Curr Opin Gastroenterol 2006;22:551-560. https://doi.org/10.1097/01.mog.0000239872.12081.a4
  7. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 1987;2:57-62.
  8. Cowling MG, Adam AN. Internal stenting in malignant biliary obstruction. World J Surg 2001;25:355-359. https://doi.org/10.1007/s002680020384
  9. England RE, Martin DF. Endoscopic and percutaneous intervention in malignant obstructive jaundice. Cardiovasc Intervent Radiol 1996;19: 381-387. https://doi.org/10.1007/BF02577624
  10. Naggar E, Krag E, Matzen P. Endoscopically inserted biliary endoprosthesis in malignant obstructive jaundice. A survey of the literature. Liver 1990;10:321-324.
  11. Dowsett JF, Vaira D, Hatfield AR, et al. Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 1989;96:1180-1186. https://doi.org/10.1016/0016-5085(89)91639-9
  12. Kaufman SL. Percutaneous palliation of unresectable pancreatic cancer. Surg Clin North Am 1995;75:989-999. https://doi.org/10.1016/S0039-6109(16)46741-1
  13. Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepa-tol 2004;2:273-285. https://doi.org/10.1016/S1542-3565(04)00055-2
  14. Dumonceau JM, Heresbach D, Devière J, et al. Biliary stents: models and methods for endoscopic stenting. Endoscopy 2011;43:617-626. https://doi.org/10.1055/s-0030-1256315
  15. Raijman I. Biliary and pancreatic stents. Gastrointest Endosc Clin N Am 2003;13:561-592. https://doi.org/10.1016/S1052-5157(03)00069-2
  16. Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc 1988;34:412-417. https://doi.org/10.1016/S0016-5107(88)71407-8
  17. Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 1998;47:1-7. https://doi.org/10.1016/S0016-5107(98)70291-3
  18. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Rando-mised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992;340:1488-1492. https://doi.org/10.1016/0140-6736(92)92752-2
  19. Soderlund C, Linder S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc 2006;63:986-995. https://doi.org/10.1016/j.gie.2005.11.052
  20. Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 2003;57:178-182. https://doi.org/10.1067/mge.2003.66
  21. O'Brien S, Hatfield AR, Craig PI, Williams SP. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut 1995;36:618-621. https://doi.org/10.1136/gut.36.4.618
  22. Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993;25:207-212. https://doi.org/10.1055/s-2007-1010294
  23. Stern N, Sturgess R. Endoscopic therapy in the management of malignant biliary obstruction. Eur J Surg Oncol 2008;34:313-317. https://doi.org/10.1016/j.ejso.2007.07.210
  24. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet 2005;366:1303-1314. https://doi.org/10.1016/S0140-6736(05)67530-7
  25. Kanasaki S, Furukawa A, Kane T, Murata K. Polyurethane-covered Nitinol Strecker stents as primary palliative treatment of malignant biliary obstruction. Cardiovasc Intervent Radiol 2000;23:114-120. https://doi.org/10.1007/s002709910023
  26. Park do H, Kim MH, Choi JS, et al. Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative an-alysis. Clin Gastroenterol Hepatol 2006;4:790-796. https://doi.org/10.1016/j.cgh.2006.03.032
  27. Suk KT, Kim HS, Kim JW, et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006;64:522-529. https://doi.org/10.1016/j.gie.2006.06.022
  28. Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2006;4:1148-1153. https://doi.org/10.1016/j.cgh.2006.06.004
  29. Nakai Y, Isayama H, Komatsu Y, et al. Efficacy and safety of the cover-ed Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc 2005;62:742-748. https://doi.org/10.1016/j.gie.2005.06.030
  30. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc 2005;61:528-533. https://doi.org/10.1016/S0016-5107(04)02593-3
  31. Bezzi M, Zolovkins A, Cantisani V, et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc In-terv Radiol 2002;13:581-589. https://doi.org/10.1016/S1051-0443(07)61651-0
  32. Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obst-ruction. Gastrointest Endosc 2011;74:321-327. https://doi.org/10.1016/j.gie.2011.03.1249
  33. Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncover-ed Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc 2006;63:996-1000. https://doi.org/10.1016/j.gie.2005.11.054
  34. Telford JJ, Carr-Locke DL, Baron TH, et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 2010;72:907-914. https://doi.org/10.1016/j.gie.2010.08.021
  35. Kullman E, Frozanpor F, Söderlund C, et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 2010;72:915-923. https://doi.org/10.1016/j.gie.2010.07.036
  36. Isayama H, Komatsu Y, Tsujino T, et al. A prospective randomised study of "covered" versus "uncovered" diamond stents for the management of distal malignant biliary obstruction. Gut 2004;53:729-734. https://doi.org/10.1136/gut.2003.018945
  37. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001; 234:507-517. https://doi.org/10.1097/00000658-200110000-00010
  38. Pichlmayr R, Weimann A, Klempnauer J, et al. Surgical treatment in pro-ximal bile duct cancer. A single-center experience. Ann Surg 1996;224: 628-638. https://doi.org/10.1097/00000658-199611000-00007
  39. Liu CL, Lo CM, Lai EC, Fan ST. Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. Arch Surg 1998;133:293-296. https://doi.org/10.1001/archsurg.133.3.293
  40. Singhal D, van Gulik TM, Gouma DJ. Palliative management of hilar cholangiocarcinoma. Surg Oncol 2005;14:59-74. https://doi.org/10.1016/j.suronc.2005.05.004
  41. Schima W, Prokesch R, Osterreicher C, et al. Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction. Clin Radiol 1997;52:213-219. https://doi.org/10.1016/S0009-9260(97)80275-9
  42. Vienne A, Hobeika E, Gouya H, et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010;72:728-735. https://doi.org/10.1016/j.gie.2010.06.040
  43. Singh V, Singh G, Gupta V, Gupta R, Kapoor R. Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction. Hepatobiliary Pancreat Dis Int 2010;9:88-92.
  44. Freeman ML, Overby C. Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 2003;58:41-49. https://doi.org/10.1067/mge.2003.292
  45. Polydorou AA, Chisholm EM, Romanos AA, et al. A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. Endoscopy 1989;21:266-271. https://doi.org/10.1055/s-2007-1012966
  46. Nguyen-Tang T, Dumonceau JM. A new method to facilitate bilateral hepatic duct drainage: simultaneous insertion of two thin 6-Fr self-expandable metal stents. Endoscopy 2011;43 Suppl 2 UCTN:E24-E25. https://doi.org/10.1055/s-0030-1255945
  47. Hookey LC, Le Moine O, Deviere J. Use of a temporary plastic stent to facilitate the placement of multiple self-expanding metal stents in malignant biliary hilar strictures. Gastrointest Endosc 2005;62:605-609. https://doi.org/10.1016/j.gie.2005.04.051
  48. Silverman W, Slivka A. New technique for bilateral metal mesh stent insertion to treat hilar cholangiocarcinoma. Gastrointest Endosc 1996;43: 61-63. https://doi.org/10.1016/S0016-5107(96)70263-8
  49. Lee JH, Kang DH, Kim JY, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent. Gastrointest Endosc 2007;66:364-369. https://doi.org/10.1016/j.gie.2006.12.061
  50. Hwang JC, Kim JH, Lim SG, Kim SS, Yoo BM, Cho SW. Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: prospective long-term study. Scand J Gastroenterol 2011;46: 326-332. https://doi.org/10.3109/00365521.2010.536253
  51. Park do H, Lee SS, Moon JH, et al. Newly designed stent for endoscopic bilateral stent-in-stent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos). Gastrointest Endosc 2009;69:1357-1360. https://doi.org/10.1016/j.gie.2008.12.250
  52. Kawamoto H, Tsutsumi K, Harada R, et al. Endoscopic deployment of multiple JOSTENT SelfX is effective and safe in treatment of malignant hilar biliary strictures. Clin Gastroenterol Hepatol 2008;6:401-408. https://doi.org/10.1016/j.cgh.2007.12.036
  53. Baer HU, Rhyner M, Stain SC, et al. The effect of communication between the right and left liver on the outcome of surgical drainage for jaundice due to malignant obstruction at the hilus of the liver. HPB Surg 1994;8:27-31. https://doi.org/10.1155/1994/17262
  54. De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 2001;53:547-553. https://doi.org/10.1067/mge.2001.113381
  55. De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc 2003;58:50-53. https://doi.org/10.1067/mge.2003.310
  56. Freeman ML, Sielaff TD. A modern approach to malignant hilar biliary obstruction. Rev Gastroenterol Disord 2003;3:187-201.
  57. Deviere J, Baize M, de Toeuf J, Cremer M. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 1988;34:95-101. https://doi.org/10.1016/S0016-5107(88)71271-7
  58. Hintze RE, Abou-Rebyeh H, Adler A, Veltzke-Schlieker W, Felix R, Wiedenmann B. Magnetic resonance cholangiopancreatography-guided unilateral endoscopic stent placement for Klatskin tumors. Gastrointest Endosc 2001;53:40-46. https://doi.org/10.1067/mge.2001.111388
  59. Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51 Suppl 6:VI1-VI9. https://doi.org/10.1136/gut.51.1.e1
  60. Abu-Hamda EM, Baron TH. Endoscopic management of cholangiocarcinoma. Semin Liver Dis 2004;24:165-175. https://doi.org/10.1055/s-2004-828893
  61. Wagner HJ, Knyrim K, Vakil N, Klose KJ. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 1993;25:213-218. https://doi.org/10.1055/s-2007-1010295
  62. Anderson CD, Pinson CW, Berlin J, Chari RS. Diagnosis and treatment of cholangiocarcinoma. Oncologist 2004;9:43-57.
  63. Dumas R, Demuth N, Buckley M, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique. Gastrointest Endosc 2000;51:334-338. https://doi.org/10.1016/S0016-5107(00)70364-6
  64. Peters RA, Williams SG, Lombard M, Karani J, Westaby D. The management of high-grade hilar strictures by endoscopic insertion of self-expanding metal endoprostheses. Endoscopy 1997;29:10-16. https://doi.org/10.1055/s-2007-1004054
  65. Sung J. Are covered stents superior to uncovered stents in the management of malignant biliary obstruction? Nat Clin Pract Gastroenterol Hepatol 2004;1:20-21.

Cited by

  1. Otaru consensus on biliary stenting for unresectable distal malignant biliary obstruction vol.25, pp.2, 2011, https://doi.org/10.1111/den.12069
  2. Technical Tips and Issues of Biliary Stenting, Focusing on Malignant Hilar Obstruction vol.46, pp.3, 2011, https://doi.org/10.5946/ce.2013.46.3.260
  3. Functional Self-Expandable Metal Stents in Biliary Obstruction vol.46, pp.5, 2011, https://doi.org/10.5946/ce.2013.46.5.515
  4. Bilateral Metallic Stenting in Malignant Hilar Obstruction vol.47, pp.5, 2011, https://doi.org/10.5946/ce.2014.47.5.440
  5. Paclitaxel-eluting nanofiber-covered self-expanding nonvascular stent for palliative chemotherapy of gastrointestinal cancer and its related stenosis vol.16, pp.6, 2011, https://doi.org/10.1007/s10544-014-9894-9
  6. An Update to Hepatobiliary Stents vol.3, pp.1, 2015, https://doi.org/10.14218/jcth.2015.00040
  7. Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors vol.48, pp.3, 2011, https://doi.org/10.5946/ce.2015.48.3.201
  8. Recent Advances in Gastrointestinal Stent Development vol.48, pp.3, 2015, https://doi.org/10.5946/ce.2015.48.3.209
  9. Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry vol.60, pp.7, 2015, https://doi.org/10.1007/s10620-015-3558-3
  10. A district general hospital experience of palliative biliary stenting vol.5, pp.3, 2011, https://doi.org/10.1136/bmjspcare-2014-000752
  11. Radiofrequency ablation for pancreatobiliary disease vol.32, pp.5, 2011, https://doi.org/10.1097/mog.0000000000000300
  12. Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist vol.5, pp.1, 2011, https://doi.org/10.18528/gii150027
  13. Current Status of Biliary Metal Stents vol.49, pp.2, 2016, https://doi.org/10.5946/ce.2016.023
  14. Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta‐analysis vol.17, pp.11, 2016, https://doi.org/10.1111/1751-2980.12429
  15. Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction vol.12, pp.6, 2011, https://doi.org/10.5009/gnl17468
  16. Endoscopic palliation of biliary obstruction vol.120, pp.1, 2019, https://doi.org/10.1002/jso.25483
  17. Biliary stenting for hilar malignant biliary obstruction vol.32, pp.2, 2011, https://doi.org/10.1111/den.13549
  18. Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis vol.8, pp.3, 2011, https://doi.org/10.1055/a-1067-4326
  19. Feasibility and efficacy evaluation of metallic biliary stents eluting gemcitabine and cisplatin for extrahepatic cholangiocarcinoma vol.26, pp.31, 2011, https://doi.org/10.3748/wjg.v26.i31.4589
  20. Multidisciplinary Approach to Malignant Biliary Obstruction vol.4, pp.3, 2011, https://doi.org/10.1055/s-0040-1717085
  21. Endoscopic revision efficacy after clinically successful bilateral metal stenting for advanced malignant hilar obstruction vol.35, pp.12, 2011, https://doi.org/10.1111/jgh.15123
  22. Locoregional Treatments in Cholangiocarcinoma and Combined Hepatocellular Cholangiocarcinoma vol.13, pp.13, 2011, https://doi.org/10.3390/cancers13133336
  23. Proper management of inoperable malignant hilar biliary obstruction: Endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, or percutaneous approach? vol.10, pp.3, 2021, https://doi.org/10.18528/ijgii210035
  24. A Recent Update on Endoscopic Drainage of Advanced Malignant Hilar Obstruction vol.78, pp.2, 2011, https://doi.org/10.4166/kjg.2021.111
  25. Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction vol.62, pp.12, 2011, https://doi.org/10.1177/0284185120978512