Optimum Palliation of Inoperable Hilar Cholangiocarcinoma: Comparative Assessment of the Efficacy of Plastic and Self-Expanding Metal Stents

Raju, Ramu; Jaganmohan, Sathya; Ross, William A.; Davila, Marta; Javle, Milind; Raju, Gottumukkala S.; Lee, Jeffrey H.

doi:10.1007/s10620-010-1550-5

Cited by 92 publications

(89 citation statements)

References 36 publications

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“…In biliary obstruction in the hepatic hilum, effective drainage is difficult to achieve because of the anatomical complexity of the bile ducts. Various procedures of biliary drainage of hilar biliary obstruction have been performed: percutaneous or endoscopic routes [1][2][3][4][5] , plastic or metallic stents [6][7][8][9][10][11] , and unilateral or bilateral hepatic duct drainage [11][12][13][14][15][16][17][18][19][20][21] . However, no consensus has been reached on the optimal drainage strategy for treating biliary obstruction.…”

Section: Introductionmentioning

confidence: 99%

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Takahashi

Fukasawa

Satô

et al. 2015

WJG

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AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures (UMHBS) because no ideal strategy currently exists. METHODS:We examined 78 patients with UMHBS who underwent biliary drainage. Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention. Complications that occurred within 7 d after stent placement were considered as early complications. Before drainage, the liver volume of each section (lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography (CT) volumetry. Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture (according to the Bismuth classification). Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section. Receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff values for drained liver volume. In addition, factors associated with the effectiveness of drainage and early complications were evaluated. cirrhosis) and 50% for patients with impaired liver function (with decompensated liver cirrhosis). The sensitivity and specificity of these cutoff values were 82% and 80% for preserved liver function, and 100% and 67% for impaired liver function, respectively. Among patients who met these criteria, the rate of effective drainage among those with preserved liver function and impaired liver function was 90% and 80%, respectively. The rates of effective drainage in both groups were significantly higher than in those who did not fulfill these criteria (P < 0.001 and P = 0.02, respectively). Drainage-associated cholangitis occurred in 9 patients (12%). A smaller drained liver volume was associated with drainage-associated cholangitis (P < 0.01). RESULTS: CONCLUSION:Liver volume drainage ≥ 33% in patients with preserved liver function and ≥ 50% in patients with impaired liver function correlates with effective biliary drainage in UMHBS. Core tip: An ideal biliary drainage strategy for unresectable malignant hilar biliary strictures (UMHBS) has not been defined. The aim of our study was to identify useful criteria for predicting successful drainage of UMHBS. In the present study, multivariate analysis revealed that liver function and drained liver volume calculated by computed tomography volumetry (CTV) are independent factors of drainage effectiveness for UMHBS. Receiver operating characteristic analysis showed cutoff values of 33% of liver volume for patients with preserved liver function and 50% for patients with impaired liver function. Before attempting biliary drainage procedures, establishing an appropriate drainage strategy using CTV is important.Takahashi E, Fukasawa M, Sato T, Takano S, Kadokura M, Shindo H, Yokota Y, Enomoto N. Biliary drainage strategy of unresectable malignant hilar strictures by...

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Section: Introductionmentioning

confidence: 99%

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Takahashi

Fukasawa

Satô

et al. 2015

WJG

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“…This process has a median stent patency lasting 6 -10 months [4]- [8]. The major drawback of this treatment is that the patency of the stent is limited to a median duration of 6 -8 months in up to 50% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Several methods, such as the use of organic polymers to coat self-expandable metallic stents, substituting alloys like nitinol for stainless steel, or endobiliary photodynamic therapy (PDT), have been proposed to increase the duration of stent patency in malignant biliary obstruction but they have not been proven to be effective by sufficient data [8] [10]- [12]. Rather, they present with increased risks of side effects, such as pancreatitis and cholecystitis due to covered SEMS and cholangitis and photosensitivity due to PDT [8] [11] [12].…”

Section: Introductionmentioning

confidence: 99%

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Metal Stenting with or without Endobiliary Radiofrequency Ablation for Unresectable Extrahepatic Cholangiocarcinoma

Liang¹,

Peng²,

Cao³

et al. 2015

JCT

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Background: Retrospective comparison of stent patency and survival of patients with unresectable extrahepatic cholangiocarcinoma (CCA) treated by placement of self-expanding metal stents (SEMS) with or without endobiliary radiofrequency ablation (ERFA). Methods: Between January 2010 and September 2014, 76 patients with biliary obstruction caused by unresectable extrahepatic CCA (27 patients with Bismuth type I hilar CCA and 49 patients with distal CCA) were recruited into this study. Patients either received ERFA with SEMS (n = 34) or SEMS only (n = 42). Stent patency and survival of both groups were compared and predictors for overall survival were analyzed. Results: Demographic data were not different between the two groups. Complication rates of both groups were similar. Thirty-day stent patency was obtained in all patients and the median stent patency in the ERFA + SEMS group (9.5 months, 4.5 -14.0 months) was significantly longer than that in the SEMS group (8.4 months, 4.9 -11 months) (P = 0.024). The overall survival curve in the ERFA + SEMS group was significantly better than that of the SEMS group (P = 0.036). Multivariate Cox proportional hazards regression analyses showed that ERFA, tumor AJCC stage, extrahepatic CCA type, serum albumin and adjuvant chemotherapy were significant prognostic factors for overall patient survival. Conclusions: ERFA is effective for unresectable extrahepatic CCA and may improve metal stent patency and patient survival for unresectable extrahepatic CCA with biliary obstruction. Prospective randomized trials will be needed to confirm these findings.

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“…Median patency was 1.86 months in the plastic group and 5.56 months in the SEMS group. 4,59 In a retrospective review of 52 SEMS in 35 patients by Cheng et al, five (14%) patients with SEMS had complications, including cholangitis or early stent closure when stenting unresectable hilar cholangiocarcinoma. 4,60 Park et al studied an unusual stent with similar results.…”

Section: Plastic Vs Metal Stentingmentioning

confidence: 99%

An Update to Hepatobiliary Stents

Moy¹,

Bir²

2015

JCTH

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Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simple plastic stent technology has evolved significantly to include uncovered, partially covered, and fully covered self-expanding metal stents (SEMS) as well as magnetic, bioabsorbable, drug-eluting, and antireflux stents.

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Optimum Palliation of Inoperable Hilar Cholangiocarcinoma: Comparative Assessment of the Efficacy of Plastic and Self-Expanding Metal Stents

Cited by 92 publications

References 36 publications

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Metal Stenting with or without Endobiliary Radiofrequency Ablation for Unresectable Extrahepatic Cholangiocarcinoma

An Update to Hepatobiliary Stents

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