Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage

Chang, Wen-Hsiung; Kortan, Paul P.; Haber, Gregory B.

doi:10.1016/s0016-5107(98)70218-4

Cited by 391 publications

(291 citation statements)

References 32 publications

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“…Concerns related to performing only unilateral drainage include the inability to relieve jaundice as well as the potential for bacterial contamination of undrained ducts, particularly when a contrast medium is introduced into them (2-6). Supporters of unilateral drainage emphasize the lower complication rate, but caution that overfilling of contrast medium into undrained ducts should be avoided (7)(8)(9)(10). However, preventing overfilling with any certainty seems to be unrealistic.…”

Section: Discussionmentioning

confidence: 99%

“…PERCUTANEOUS palliation with metallic endoprostheses is the accepted method to relieve malignant biliary hilar obstruction (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Although the necessity of complete biliary drainage remains controversial, it seems certain that drainage of as much of the liver as possible is prudent (3)(4)(5)(6)(7)(8).…”

mentioning

confidence: 99%

“…Although the necessity of complete biliary drainage remains controversial, it seems certain that drainage of as much of the liver as possible is prudent (3)(4)(5)(6)(7)(8). Many reports regarding bilobar biliary stent implantation have been published (2)(3)(4)(5)(6).…”

mentioning

confidence: 99%

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Crisscross-Configured Dual Stent Placement for Trisectoral Drainage in Patients with Advanced Biliary Hilar Malignancies

Bae

Park

Choi

et al. 2008

Journal of Vascular and Interventional Radiology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Crisscross-Configured Dual Stent Placement for Trisectoral Drainage in Patients with Advanced Biliary Hilar Malignancies

Bae

Park

Choi

et al. 2008

Journal of Vascular and Interventional Radiology

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“…Injection of contrast into intrahepatic ducts which can not be adequately drained should be avoided as this is associated with worse outcomes [6]. MRCP has been advocated to assist in providing a guide to the ductal anatomy and formulating a plan for drainage [7].…”

mentioning

confidence: 99%

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

Aslanian

Jamidar

2011

Dig Dis Sci

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The majority of patients with cholangiocarcinoma present with locally unresectable disease and the median survival with radiation and chemotherapy is 7-12 months. The endoscopic palliation of inoperable hilar cholangiocarcinoma remains one of the more challenging cases for the biliary endoscopist. The endoscopist must define the anatomy without injecting contrast into ducts that will not be drained, achieve guide-wire access for unilateral or bilateral stent placement and determine what type of stent-plastic or self-expanding metal (SEMS), will best serve the patient to relieve pain and jaundice and prevent cholangitis.Raju et al.[1] present a retrospective review of 100 patients who underwent endoscopic plastic or SEMS placement for inoperable hilar cholangiocarcinoma. Patients were regularly followed to death or reintervention, and stent patency and survival were examined. In 48 patients uncovered (as expected due to the hilar location of obstruction) SEMS were placed, with plastic stents (at least one of which was 10 French) in the other 52 patients. The Bismuth Classification of lesions was similar between the groups. There was however, a greater number of Type 3 and 4 cases that received plastic stents (73.1% vs. 56.3%), potentially favoring a better outcome with SEMS. The technical success rate was high in both groups (95.8% vs. 94.2%). Bilateral stenting was performed successfully in 20/23 plastic stent patients and 5/5 SEMS. The SEMS group demonstrated significantly better stent patency (5.56 vs. 1.86 months) and required fewer re-interventions for stent obstruction (1.53 vs.4.6). The complication rate was similar in both groups (8.3% SEMS and 7.7% plastic) and there was a non-significant trend towards greater survival in the SEMS group (9.08 vs. 8.22 months). During the study time period, routine stent changes in patients with plastic stents were not performed; however, the median patency was only 1.5 months. No difference between the patency of straight and pigtail plastic stents was seen, nor was there a difference between unilateral and bilateral plastic stents or SEMS. All re-interventions were performed endoscopically, nine patients with plastic stents were converted to SEMS and plastic stents were placed within SEMS in four patients.The results of Raju et al. are similar to those of prior studies identifying less stent failure with the use of SEMS versus plastic stents for hilar tumors [2,3]. There is scant information in the way of randomized comparisons between plastic and metal stents. A study by Wagner et al.[2] is the only prospective, randomized study. Twenty patients were randomized between metal stents placed percutaneously or endoscopic stents placed by a combination of endoscopic-percutaneous technique. Perdue et al.[3] reviewed a multicenter database of 62 consecutivelyreported endoscopically-placed metal or plastic stents for hilar obstruction. Outcomes in favor of metals stents were reported in both studies.

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“…Drainage of both ductal sys− tems is desirable because there is a risk of cholangitis after endoscopic biliary in− tervention if drainage is incomplete [1,2]. The rates for mean survival, 30−day mor− tality, and death from sepsis in patients with Klatskin tumors are reported to be significantly better with bilateral self−ex− panding metal stents (SEMS) compared with unilateral stents [3]. Endoscopic placement of two parallel SEMS is techni− cally demanding.…”

mentioning

confidence: 99%

A new biliary ”Y” stent for hilar tumors

Ramchandani¹,

Lakhtakia²,

Gupta³

et al. 2007

Endoscopy

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Palliative treatment of malignant hilar biliary strictures is difficult, especially when the stricture involves both the right and left hepatic ducts (Bismuth types II and higher). Drainage of both ductal sys− tems is desirable because there is a risk of cholangitis after endoscopic biliary in− tervention if drainage is incomplete [1,2]. The rates for mean survival, 30−day mor− tality, and death from sepsis in patients with Klatskin tumors are reported to be significantly better with bilateral self−ex− panding metal stents (SEMS) compared with unilateral stents [3]. Endoscopic placement of two parallel SEMS is techni− cally demanding. To circumvent this problem, a "Y" stent has been designed which consists of two uncovered SEMS (Niti−S Biliary stent, Y type [Endoscopic approach]; TaeWoong Medical Co. Ltd., Kyonggi−Do, South Korea): the first SEMS has a radiologically marked segment with wider mesh holes in its middle part, through which the second stent is deliv− ered on the other side (Figure 1). We re− port a case of hilar cholangiocarcinoma (Bismuth type III), which was successfully palliatively treated using this biliary Y stent.A 66−year−old woman presented with jaundice of 3 weeks duration, and with weight loss and pruritus. Abdominal com− puted tomography confirmed the exis− tence of a hilar mass, which was surgical− ly unresectable. Endoscopic retrograde cholangiopancreatography revealed hilar cholangiocarcinoma with a Bismuth type III anatomical configuration (Figure 2). A guide wire (0.035−inch Jagwire; Microva− sive Boston Scientific, Natick, Massachu− setts, USA) was negotiated into the right biliary system. The first SEMS was de− ployed over this guide wire, with the wider mesh holes positioned below the bifurcation. A second Jagwire was then passed through the gap in the first SEMS into the left ductal system, over which the second SEMS was deployed in a "Y" fashion ( Figure 3). This is the first case re− port describing the placement of a Y bili− ary stent in a hilar biliary stricture. The patient was jaundice− and pruritis−free 10 weeks after the procedure. The Y stent appears to represent a technically easier option for the managment of malignant hilar biliary strictures.

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Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage

Cited by 391 publications

References 32 publications

Crisscross-Configured Dual Stent Placement for Trisectoral Drainage in Patients with Advanced Biliary Hilar Malignancies

Crisscross-Configured Dual Stent Placement for Trisectoral Drainage in Patients with Advanced Biliary Hilar Malignancies

Ongoing Challenges in the Endoscopic Management of Hilar Cholangiocarcinoma

A new biliary ”Y” stent for hilar tumors

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