Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos)

Inoue, Tadahisa; Okumura, Fumihiro; Naitoh, Itaru; Fukusada, Shigeki; Kachi, Kenta; Ozeki, Takanori; Anbe, Kaiki; Iwasaki, Hiroyasu; Mizushima, Takashi; Kobayashi, Yuji; Ishii, Norimitsu; Ito, Kiyoaki; Kondo, Hiromu; Hayashi, Kazuki; Yoneda, Masashi; Sano, Hitoshi

doi:10.1016/j.gie.2016.03.1501

Cited by 35 publications

(45 citation statements)

References 15 publications

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“…Recently, a thin (6 mm in diameter) removable covered stent has been developed and it has been reported that there were no serious problems associated with its use for reintervention in cases of PHC. 9,10 The survival period associated with their use was 216-250 days, which were inferior to our data (268 days), because there was no concern about the feasibility of continued chemotherapy. Furthermore, multiple covered SEMS placement was associated with the risk of obstruction of other bile duct branches, refractory cholangitis and liver abscess, which are critical conditions.…”

Section: Discussioncontrasting

confidence: 88%

“…No significant differences in the outcomes have been reported between stent-in-stent and side-by-side deployment of U-SEMSs in patients with UPHC. 8 Recently, small-caliber removal covered metal stents have been tried in patients with UPHC, 9,10 however, data for reinterventions are insufficient. The need for stent placement in patients with UPHC tends to increase as the disease advances.…”

Section: Introductionmentioning

confidence: 99%

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The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

Iwasaki

Kubota

Kurita

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: Placement of uncovered self-expandable metallic stents (U-SEMSs) of patients with unresectable perihilar cholangiocarcinoma (UPHC) is recommended as the treatment of first choice to address bile stasis. The aim of this study was to determine which of the following two endoscopic stents might be the stent of first choice for the treatment of biliary stasis in patients with UPHC: plastic stents (PSs) or U-SEMSs. Methods: U-SEMSs, deployed as a stent-in-stent, were selected as the stents of first choice from 2013 and 2014, while PSs began to be selected as the stents of first choice from 2015 onward. Results: The median time to recurrent biliary obstruction were 66 days in the PS group (N = 38) and 105 days in the U-SEMS group (N = 37; P = .04). Emergency endoscopy was necessitated in 76.3% (29/38) of patients of the PS group and 54.1% (20/37) of patients of the U-SEMS group (P = .0434). The success rate of the first reintervention was 96.5% (27/29) in the PS group and 55% (11/20) in the U-SEMS group (P = .0002). Sustainable chemotherapy could be carried out in 55.2% of patients in the PS group and 32.4% of patients in the U-SEMS group (P = .0472). Multivariate analysis identified selection of U-SEMS as the stent of first choice as the only independent factor predictive of successful reintervention (P = .0016, odds ratio = 0.058). However, the stent selection was not an independent factor for feasible chemotherapy. Conclusions: Plastic stent placement could enhance the success rate of reintervention in patients with UPHC and might be facilitated by sustainable chemotherapy. However, stent selection might not have an influence on the prognosis.

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Section: Discussioncontrasting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

Iwasaki

Kubota

Kurita

et al. 2020

J Hepato Biliary Pancreat

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“…The Asia‐Pacific Working Group for hepatobiliary cancers have reported that optimal palliative stenting for hilar cholangiocarcinoma requires draining ≥50% or more of the liver volume . Therefore, bilateral SEMS can be deployed under such circumstances using side‐by‐side (SBS) or stent‐in‐stent (SIS) techniques . The incidence of complications seems higher when stents are deployed using SBS technique .…”

Section: Introductionmentioning

confidence: 99%

Single‐session multiple stent deployment using moving cell stent without dilating initial stent mesh to treat malignant hilar biliary obstruction (with videos)

Ogura

Takenaka

Shiomi

et al. 2019

J Hepato Biliary Pancreat

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Background Malignant hilar biliary obstruction (MHBO) can be treated with bilateral self-expandable metal stents (SEMS) deployed using side-by-side (SBS) or stent-instent (SIS) techniques. Moving cell stents (MCS) are a novel type of SEMS. The present study evaluated the technical feasibility of treating MHBO using bilateral novel uncovered SEMS to insert an SIS technique without dilating the mesh of a first stent within a single session. Method We retrospectively assessed patients who were complicated with obstructive jaundice due to MHBO between August and December 2018. Technical success was defined as the deployment of a bilateral MCS into two or more biliary tracts using SIS technique without a dilation device. Results The present study analyzed data from 23 consecutive patients who were complicated with MHBO. Bilateral SIS technique with MCS was deployed in 22 (95.6%) of the 23 patients without dilating the mesh of the first stent. Multiple guidewire insertion failed in one patient with Bismuth-type IV. The median procedural duration was 33.6 min. Time to recurrent biliary obstruction was 230 days. Severe adverse events were not seen in any patients. Conclusion In conclusion, uncovered moving cell SEMS might facilitate bilateral stent deployment using SIS technique.

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“…However, FCSEMS deployment for hepatic hilar obstruction is not usually recommended because a branch of the intrahepatic bile duct can be obstructed. Recently, side-by-side stent placement technique using FCSEMS has been developed [9] due to metal stent improvements. In the presented technique, the left hepatic, anterior, and posterior bile ducts were obstructed.…”

Section: Discussionmentioning

confidence: 99%

Triple Covered Metal Stent Deployment Using Side-by-Side Technique for Hemobilia due to Hepatocellular Carcinoma (with Video)

Ogura

Yamada

et al. 2019

Dig Dis

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A hepatocellular carcinoma (HCC) rarely expands into the biliary tract. In this situation, because of its hypervascular nature, cholangitis or hemobilia may sometimes occur. Surgery is one of the options in this situation. However, patients with HCC and bile duct invasion are sometimes in a poor general condition, as in the case presented in this report. For such patients, surgical treatment may need to be invasive. Thus, here we report technical tips for triple covered metal stent deployment using side-by-side technique for hemobilia due to HCC. After guidewire deployments at the left, anterior, and posterior bile ducts, 6-mm covered self-expandable metal stents were placed at each bile duct. This may be useful for high-grade hepatic hilar obstruction due to HCC because drainage and hemostasis effects are obtained.

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Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos)

Cited by 35 publications

References 15 publications

The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

Single‐session multiple stent deployment using moving cell stent without dilating initial stent mesh to treat malignant hilar biliary obstruction (with videos)

Triple Covered Metal Stent Deployment Using Side-by-Side Technique for Hemobilia due to Hepatocellular Carcinoma (with Video)

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