Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video)

Lee, Tae Hoon; Kim, Tae Hyeon; Lee, Moon Sung; Lee, Sang Hyub; Hwangbo, Young; Hyun, Jong Jin; Choi, Jun Ho; Jeong, Seok; Kim, Jong Hyeok; Park, Do Hyun; Han, Joung Ho; Park, Sang Heum

doi:10.1016/j.gie.2017.04.037

Cited by 160 publications

(206 citation statements)

References 33 publications

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“…However, these results also included some cases in which plastic stents were used, and were based on a retrospective analysis. A recent randomized study of unilateral and bilateral drainage using SEMS in patients with advanced HMBO showed that bilateral drainage had superior stent patency, a lower reintervention rate, and a similar adverse event rate as compared to unilateral drainage (Table ) …”

Section: Bilateral (Multi‐sectoral) Drainagementioning

confidence: 99%

Biliary stenting for hilar malignant biliary obstruction

Lee

Moon

Park

2019

Digestive Endoscopy

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Although endoscopic intervention is the mainstay for palliation of malignant biliary obstruction, a percutaneous approach has been preferred, particularly in patients with advanced highgrade hilar malignant biliary obstruction, because of the technical difficulty and risk of complications. However, recently, primary endoscopic palliation using plastic or metal stents has had higher technical and clinical success with fewer adverse events than the percutaneous approach. Endoscopic interventions are being done more and more frequently because of advances in metal stents, accessories, and techniques.However, several concerns, such as optimal stent type, number, and deployment method, remain to be resolved. Therefore, we reviewed the literature in order to identify the optimal biliary stenting strategy for patients with hilar malignant biliary obstruction, focusing on stent type (plastic vs metal), number (unilateral [single] vs bilateral [multiple]), and deployment method (stent-in-stent vs stent-by-stent). NA, not available; NS, not significant; RCT, randomized controlled trial; SEMS, self-expandable metal stent. † 30-day mortality. ‡ Six-month patency rate. Digestive Endoscopy 2020; 32: 275-286 Biliary stenting for HMBO 277 157 180 26 Kawakubo et al. 70 SBS Zilver 84.6 (11/13) NA 38 (5/13) 263 206 194 NA, not available; SBS, stent-by-stent; SEMS, self-expandable metal stents; SIS, stent-in-stent. Digestive Endoscopy 2020; 32: 275-286 Biliary stenting for HMBO 281 Digestive Endoscopy 2020; 32: 275-286 Biliary stenting for HMBO 285

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Section: Bilateral (Multi‐sectoral) Drainagementioning

confidence: 99%

Biliary stenting for hilar malignant biliary obstruction

Lee

Moon

Park

2019

Digestive Endoscopy

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“…Currently, there exists no definite consensus on the best endoscopic drainage method for performing unilateral or bilateral stenting in patients with UMHBO. To date, three RCTs [3,6,7] have compared outcomes of unilateral and bilateral stenting ( Table 2). In an RCT conducted by De Palma et al [6] that compared the results of unilateral and bilateral PS deployment, unilateral stenting demonstrated a significantly higher rate of technical success (89 vs 77%; p = 0.041), clinical success (81 vs 73%; p = 0.048), and a significantly lower rate of early complication (19 vs 27%; p = 0.026) than bilateral stenting.…”

Section: Unilateral (Single) Versus Bilateral (Multiple) Stentingmentioning

confidence: 99%

“…Recent studies have revealed higher technical success rates (90-100%) in bilateral SEMS deployment [8][9][10]. Most recently, Lee et al [7] reported an RCT comparing outcomes of unilateral and bilateral stenting for high-grade UMHBO (Bismuth type II-IV). Although technical success rate was equivalent (unilateral 100% vs …”

Section: Unilateral (Single) Versus Bilateral (Multiple) Stentingmentioning

confidence: 99%

Endoscopic biliary stenting for unresectable malignant hilar obstruction

Fukasawa

Takano

Shindo

et al. 2017

Clin J Gastroenterol

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“…Self‐expandable metallic stent (SEMS) placement is recommended for unresectable malignant hilar biliary obstruction (MHBO) because of their longer patency than plastic stents (PS) . Although the appropriate drainage area remains debatable, a recent randomized study showed that bilateral drainage resulted in fewer reinterventions and better stent patency than unilateral drainage . Bilateral SEMS placement can be carried out using the following two approaches: side‐by‐side (SBS) and stent‐in‐stent (SIS) methods .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Although the appropriate drainage area remains debatable, a recent randomized study showed that bilateral drainage resulted in fewer reinterventions and better stent patency than unilateral drainage. 4 Bilateral SEMS placement can be carried out using the following two approaches: side-by-side (SBS) and stent-in-stent (SIS) methods. 5 A consensus on the optimal approach has yet to be reached; 6,7 therefore, the method selected currently depends upon the experience and preferences of the endoscopist.…”

Section: Introductionmentioning

confidence: 99%

Combined side‐by‐side and stent‐in‐stent method for triple metal stenting in patients with malignant hilar biliary obstruction

Inoue

Ibusuki

Kitano

et al. 2019

Digestive Endoscopy

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Background and Aim Endoscopic placement of three branched self‐expandable metallic stents (SEMS) for high‐grade malignant hilar biliary obstruction (MHBO) is technically challenging. We examined the feasibility and efficacy of a novel stenting method combining side‐by‐side and stent‐in‐stent (SBSIS) placement for MHBO. Methods Between January 2015 and December 2018, 27 consecutive patients with high‐grade MHBO underwent SBSIS placement. We evaluated the technical success, functional success, recurrent biliary obstruction (RBO), adverse events other than RBO, and reintervention success rates associated with SBSIS placement. Results Technical success rate was 85% (23/27). Insertion of the third SEMS failed in four patients, and median diameter of the common bile duct (CBD) was significantly smaller in patients in whom technical failure occurred (5 mm vs 8 mm; P = 0.004). Functional success was achieved in all patients in whom the procedure was a technical success. Rate of adverse events other than RBO was 15% (4/27). RBO rate was 43% (10/23), and median time to RBO was 157 days. Success rate of endoscopic reintervention for RBO was 89% (8/9). Conclusion SBSIS placement showed favorable results and is a promising option in patients with high‐grade MHBO requiring triple metal stenting. However, it might be preferable to avoid SBSIS in patients with a narrow CBD. Clinical Trial Registry: UMIN000035721

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Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video)

Cited by 160 publications

References 33 publications

Biliary stenting for hilar malignant biliary obstruction

Biliary stenting for hilar malignant biliary obstruction

Endoscopic biliary stenting for unresectable malignant hilar obstruction

Combined side‐by‐side and stent‐in‐stent method for triple metal stenting in patients with malignant hilar biliary obstruction

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