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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

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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.

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Abbreviations

CBD:

Common bile duct

IHD:

Intrahepatic bile duct

PTBD:

Percutaneous transhepatic biliary drainage

SEMS:

Self-expandable metal stent

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Acknowledgments

We acknowledge the support and assistance given by the nursing staff at the participating centers for this study. All authors disclosed no financial relationships relevant to this publication.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea

    Tae Hoon Lee & Sang-Heum Park

  2. Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Do Hyun Park & Sang Soo Lee

  3. Department of Internal Medicine, Digestive Disease Center, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Hyun Jong Choi & Jong Ho Moon

  4. Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Republic of Korea

    Jun Kyu Lee

  5. Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea

    Tae Hyeon Kim

  6. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

    Jong Hyeok Kim

  7. Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea

    Seok Jeong

Authors
  1. Tae Hoon Lee
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  2. Do Hyun Park
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  3. Sang Soo Lee
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  9. Sang-Heum Park
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  10. Jong Ho Moon
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Correspondence to Do Hyun Park.

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Lee, T.H., Park, D.H., Lee, S.S. et al. 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. Dig Dis Sci 58, 547–555 (2013). https://doi.org/10.1007/s10620-012-2346-6

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  • DOI: https://doi.org/10.1007/s10620-012-2346-6

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