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)

被引:87
作者
Park, Do Hyun [1 ]
Lee, Sang Soo [1 ]
Moon, Jong Ho [2 ]
Choi, Hyun Jong [2 ]
Cha, Sang-Woo [3 ]
Kim, Jong Hyeok [4 ]
Seo, Dong-Wan [1 ]
Lee, Sung-Koo [1 ]
Park, Sang-Heum [5 ]
Lee, Moon-Sung [2 ]
Kim, Sun-Joo [5 ]
Kim, Myung-Hwan [1 ]
机构
[1] Univ Ulsan, Dept Internal Med, Coll Med, Asan Med Ctr, Seoul, South Korea
[2] Soon Chun Hyang Univ, Dept Internal Med, Sch Med, Puchon 420767, South Korea
[3] Eulji Univ, Dept Internal Med, Coll Med, Eulji Univ Hosp, Taejon, South Korea
[4] Hallym Univ, Dept Internal Med, Sacred Heart Hosp, Anyang, South Korea
[5] Soon Chun Hyang Univ, Dept Internal Med, Cheonan Hosp, Cheonan, South Korea
关键词
OBSTRUCTION; DRAINAGE; PALLIATION;
D O I
10.1016/j.gie.2008.12.250
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
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 in 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 an), 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 clays and 150 clays, 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.
引用
收藏
页码:1357 / 1360
页数:4
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