Gut and Liver

The Korean Association for the Study of the Liver (대한간학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Yang, Min Jae (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Kim, Jin Hong (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Hwang, Jae Chul (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Yoo, Byung Moo (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lee, Sang Hyub (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Ryu, Ji Kon (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Yong-Tae (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Woo, Sang Myung (Center for Liver Cancer, National Cancer Center) ;
  • Lee, Woo Jin (Center for Liver Cancer, National Cancer Center) ;
  • Jeong, Seok (Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine) ;
  • Lee, Don Haeng (Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine)
  • Received : 2017.10.23
  • Accepted : 2018.03.09
  • Published : 2018.11.15
⟨ Previous Next ⟩

Abstract

Background/Aims: Although endoscopic bilateral stent-instent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. Methods: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. Results: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. Conclusions: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement.

Keywords

References

  1. Soehendra N, Reynders-Frederix V. Palliative bile duct drainage: a new endoscopic method of introducing a transpapillary drain. Endoscopy 1980;12:8-11. https://doi.org/10.1055/s-2007-1021702
  2. 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
  3. Kim JH. Endoscopic stent placement in the palliation of malignant biliary obstruction. Clin Endosc 2011;44:76-86. https://doi.org/10.5946/ce.2011.44.2.76
  4. 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
  5. Park DH, 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
  6. 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
  7. Kogure H, Isayama H, Kawakubo K, et al. Endoscopic bilateral metallic stenting for malignant hilar obstruction using newly designed stents. J Hepatobiliary Pancreat Sci 2011;18:653-657. https://doi.org/10.1007/s00534-011-0407-4
  8. Kogure H, Isayama H, Nakai Y, et al. Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study. Surg Endosc 2011;25:463-467. https://doi.org/10.1007/s00464-010-1194-8
  9. Kogure H, Isayama H, Nakai Y, et al. High single-session success rate of endoscopic bilateral stent-in-stent placement with modified large cell Niti-S stents for malignant hilar biliary obstruction. Dig Endosc 2014;26:93-99. https://doi.org/10.1111/den.12055
  10. Lee JM, Lee SH, Chung KH, et al. Small cell- versus large cell-sized metal stent in endoscopic bilateral stent-in-stent placement for malignant hilar biliary obstruction. Dig Endosc 2015;27:692-699. https://doi.org/10.1111/den.12466
  11. Mukai T, Yasuda I, Isayama H, et al. Comparison of axial force and cell width of self-expandable metallic stents: which type of stent is better suited for hilar biliary strictures? J Hepatobiliary Pancreat Sci 2011;18:646-652. https://doi.org/10.1007/s00534-011-0406-5
  12. Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stentin-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 2012;57:3279-3285. https://doi.org/10.1007/s10620-012-2270-9
  13. Kim KM, Lee KH, Chung YH, et al. A comparison of bilateral stenting methods for malignant hilar biliary obstruction. Hepatogastroenterology 2012;59:341-346.
  14. Law R, Baron TH. Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and side-by-side stent deployment. Dig Dis Sci 2013;58:2667-2672. https://doi.org/10.1007/s10620-013-2671-4
  15. Lee TH, Moon JH, Kim JH, et al. Primary and revision efficacy of cross-wired metallic stents for endoscopic bilateral stent-in-stent placement in malignant hilar biliary strictures. Endoscopy 2013;45:106-113. https://doi.org/10.1055/s-0032-1326345
  16. Kawakubo K, Kawakami H, Kuwatani M, et al. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study. J Hepatobiliary Pancreat Sci 2015;22:151-155. https://doi.org/10.1002/jhbp.173
  17. 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
  18. Larghi A, Tringali A, Lecca PG, Giordano M, Costamagna G. Management of hilar biliary strictures. Am J Gastroenterol 2008;103:458-473. https://doi.org/10.1111/j.1572-0241.2007.01645.x
  19. 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
  20. 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
  21. Liberato MJ, Canena JM. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients. BMC Gastroenterol 2012;12:103. https://doi.org/10.1186/1471-230X-12-103
  22. Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol 2009;24:552-557. https://doi.org/10.1111/j.1440-1746.2008.05750.x
  23. Lee TH, Kim TH, Moon JH, et al. Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video). Gastrointest Endosc 2017;86:817-827. https://doi.org/10.1016/j.gie.2017.04.037
  24. Moon JH, Rerknimitr R, Kogure H, Nakai Y, Isayama H. Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques. J Hepatobiliary Pancreat Sci 2015;22:650-656. https://doi.org/10.1002/jhbp.270
  25. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383-393. https://doi.org/10.1016/S0016-5107(91)70740-2
  26. Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:24-34. https://doi.org/10.1007/s00534-012-0561-3
  27. Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2013;20:35-46. https://doi.org/10.1007/s00534-012-0568-9

Cited by

  1. Recent innovations in therapeutic endoscopy for pancreatobiliary diseases vol.32, pp.3, 2020, https://doi.org/10.1111/den.13473
  2. Novel concept of bared type metallic stent for endoscopic bilateral stent‐in‐stent placement in patients with hilar malignant biliary obstruction (with video) vol.27, pp.5, 2018, https://doi.org/10.1002/jhbp.698
  3. Placement of a newly designed partially covered T- or Y-configured self-expanding metallic stent for hilar biliary obstruction: technical note vol.125, pp.10, 2018, https://doi.org/10.1007/s11547-020-01196-w
  4. The Comparison of Endoscopic Biliary Drainage in Malignant Hilar Obstruction by Cholangiocarcinoma: Bilateral Metal Stents versus Multiple Plastic Stents vol.15, pp.6, 2018, https://doi.org/10.5009/gnl20257
  5. Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction vol.62, pp.12, 2018, https://doi.org/10.1177/0284185120978512