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) - 23/08/11
, Sang Soo Lee, MD, PhD , Jong Ho Moon, MD, PhD ⁎, Hyun Jong Choi, MD, Sang-Woo Cha, MD, PhD, Jong Hyeok Kim, MD, PhD, Dong-Wan Seo, MD, PhD, Sung-Koo Lee, MD, PhD, Sang-Heum Park, MD, PhD, Moon-Sung Lee, MD, PhD, Sun-Joo Kim, MD, PhD, Myung-Hwan Kim, MD, PhDReprint requests: Jong Ho Moon, MD, PhD, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Digestive Disease Center, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon 420-767, Korea.Seoul, Bucheon, Korea
Abstract |
Background |
Endoscopic management of malignant hilar biliary strictures is difficult even for an experienced endoscopist. Moreover, endoscopic placement of bilateral metal stents is considered very difficult and complicated.
Objective |
We explored the feasibility and efficacy of the placement of a newly designed metal stent for an endoscopic bilateral stent-in-stent procedure for the management of malignant hilar biliary strictures.
Design |
Multicenter prospective feasibility study.
Setting |
Five academic tertiary referral centers.
Patients |
Thirty-five patients with malignant hilar biliary strictures of Bismuth type II or higher were enrolled.
Interventions |
Bilateral stent placement by an endoscopic stent-in-stent procedure.
Main Outcome Measurements |
Technical success, functional success, early and late complications, stent patency.
Results |
The overall technical success rate of the newly designed metal stent was 94.3% (33/35). The success rate of the stent-in-stent procedure in a single session was 82% (27/33) per protocol and 77% (27/35) as intent to treat. In cases in which the initial stent-in-stent procedure failed, patients underwent the endoscopic stent-in-stent procedure for contralateral stent placement at 2 days (6%, 2/33) or 4 days (12%, 4/33) after the initial stent placement. There was no percutaneous insertion of a contralateral stent in these patients. There was no stent-related early or late complication in any enrolled patient. Functional success was 100% (33/33). Reintervention because of stent malfunction was 6% (2/33). These 2 patients showed sludge formation in the stent. During follow-up, there was no stent tumor ingrowth or overgrowth in the placed stent in any enrolled patient. According to the Kaplan-Meier analysis, median survival and stent patency were 180 days and 150 days, respectively.
Limitations |
An uncontrolled feasibility study with a small patient population and a limited follow-up period.
Conclusion |
The newly designed metal stent for the endoscopic bilateral stent-in-stent procedure may be feasible and effective for malignant hilar biliary strictures.
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| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you want to chat with an author of this article, you may contact him at jhmoon@schbc.ac.kr. |
Vol 69 - N° 7
P. 1357-1360 - giugno 2009 Ritorno al numero
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