Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: A multicenter prospective study

Tae Hoon Lee, Do Hyun Park, Sang Soo Lee, Hyun Jong Choi, Jun Kyu Lee, Tae Hyeon Kim, Jong Hyeok Kim, Seok Jeong, Sang Heum Park, Jong Ho Moon

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)547-555
Number of pages9
JournalDigestive Diseases and Sciences
Volume58
Issue number2
DOIs
StatePublished - Feb 2013

Keywords

  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic revision
  • Hilar bile duct obstruction
  • Side-by-side placement

Fingerprint

Dive into the research topics of 'Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: A multicenter prospective study'. Together they form a unique fingerprint.

Cite this