Reintervention for stent occlusion after bilateral self‐expandable metallic stent placement for malignant hilar biliary obstruction

Inoue, Tadahisa; Naitoh, Itaru; Okumura, Fumihiro; Ozeki, Takanori; Anbe, Kaiki; Iwasaki, Hiroyasu; Nishie, Hirotada; Mizushima, Takashi; Sano, Hitoshi; Nakazawa, Takahiro; Yoneda, Masashi; Joh, Takashi

doi:10.1111/den.12657

Cited by 41 publications

(35 citation statements)

References 21 publications

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“…Risk of reocclusion and patency duration after second stents were similar between plastic and SEMS. 80 In contrast, Inoue et al 81 reported that median time to recurrent biliary obstruction was significantly longer for revisionary SEMS placement than for plastic stents (131 vs 47 days, respectively; log-rank test, P = 0.005). This study investigated hilar obstruction, but a small number of patients was included.…”

Section: Figurementioning

confidence: 94%

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: Figurementioning

confidence: 94%

Biliary stenting for hilar malignant biliary obstruction

Lee

Moon

Park

2019

Digestive Endoscopy

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“…For each method, the recurrent biliary obstruction (RBO) rate has been reported as 20–55% . Reintervention is required for RBO after SEMS placement, and endoscopic reintervention (ERI) seems to be minimally invasive . However, ERI is sometimes challenging after placement of SEMS, and external drainage tubes may need to be placed after an ERI failure.…”

Section: Introductionmentioning

confidence: 99%

“…However, ERI is sometimes challenging after placement of SEMS, and external drainage tubes may need to be placed after an ERI failure. There is still insufficient evidence to recommend ERI ; therefore, bilateral SEMS placement is sometimes avoided in the management of UMHBO. In our centers, we usually perform SIS placements and have had some patients with RBO after SIS placement .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of endoscopic reintervention for self‐expandable metallic stent obstruction after stent‐in‐stent placement for malignant hilar biliary obstruction

Okuno

Mukai

Iwashita

et al. 2019

J Hepato Biliary Pancreat

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Background Bilateral self-expandable metallic stent (SEMS) placement is effective for long-term management of unresectable malignant hilar biliary obstruction (UMHBO). However, endoscopic reintervention (ERI) for bilateral SEMSs is not well-studied. This study aimed to evaluate ERI efficacy after stent-in-stent placement. Methods Data of 31 patients who underwent ERI from May 2000 to July 2018 were analyzed. Results The technical success rate was 80.7% (25/31) and no adverse events occurred. The functional success rate was 100% (25/25). In a multivariate logistic regression analysis, the angle between the bilateral SEMSs (ABBS) >104°( odds ratio 50.49, 95% CI 3.370-2131, P = 0.0039) and overgrowth (odds ratio 25.70, 95% CI 1.121-1234, P = 0.0423) were risk factors for ERI failure. Multiple liver metastases, which sometimes cause overgrowth, were also risk factors. After ERI, some patients underwent additional SEMS (n = 4), plastic stent (n = 14) placement, or internal cleaning of the initial SEMS alone (n = 7). There were no significant intergroup differences in the 50% time to recurrent biliary obstruction.Conclusions ABBS >104°and overgrowth were risk factors for ERI failure after stent-in-stent placement. In the decisionmaking process for initial SEMS placement for UMHBO, patient condition should be considered, including the angle between bilateral bile ducts and multiple liver metastases.

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“…In contrast, Inoue et al . reported that the median time to a recurrent biliary obstruction of a revisionary stent is significantly longer for placing a SEMS than that for placing a PS . The Tokyo Criteria use the term ‘recurrent biliary obstruction’ rather ‘patency’ …”

Section: Hilar Obstructionmentioning

confidence: 99%

“…10 In contrast, Inoue et al reported that the median time to a recurrent biliary obstruction of a revisionary stent is significantly longer for placing a SEMS than that for placing a PS. 11 The Tokyo Criteria use the term 'recurrent biliary obstruction' rather 'patency'. 12 CONCLUSION I N CONCLUSION, We described management strategies for acute cholangitis caused by occlusion of both distal and hilar SEMS.…”

Section: Hilar Obstructionmentioning

confidence: 99%

Management of acute cholangitis as a result of occlusion from a self‐expandable metallic stent in patients with malignant distal and hilar biliary obstructions

Shiomi

Matsumoto

Isayama

2017

Digestive Endoscopy

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Acute cholangitis as a result of common bile duct stones can be managed; however, cholangitis caused by occlusion with a biliary self-expandable metallic stent (SEMS) in patients with an unresectable malignant biliary obstruction has not been fully discussed. The acute cholangitis clinical guidelines (Tokyo Guidelines 2013) recommend following the same procedure as that used for cholangitis; however, the patient's condition, including performance status, tumor extension or staging, and prognosis must be considered. Most physicians manage cholangitis from a SEMS occlusion using a two-step procedure. They insert endoscopic drainage with a plastic stent or insert a nasobiliary drainage tube, which does not exacerbate sepsis. Addition or replacement of a biliary SEMS is required in many cases depending on the cause of the occlusion. Tumor ingrowth through the stent mesh is common in uncovered SEMS and requires placement of another stent in an in-stent method. However, covered SEMS tends to be occluded by sludge, so it must be replaced because of the bacterial biofilm that forms on the covering membrane. The location of the biliary stricture (hilar or distal) should also be considered. Strategies for managing cholangitis as a result of occlusion by a biliary SEMS remain controversial, so prospective clinical trials are needed.

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Reintervention for stent occlusion after bilateral self‐expandable metallic stent placement for malignant hilar biliary obstruction

Abstract: Revisionary SEMS placement is a suitable endoscopic reintervention method for stent occlusion following bilateral SEMS placement from the perspective of time to RBO of the revisionary stent.

Cited by 41 publications

References 21 publications

Biliary stenting for hilar malignant biliary obstruction

Biliary stenting for hilar malignant biliary obstruction

Evaluation of endoscopic reintervention for self‐expandable metallic stent obstruction after stent‐in‐stent placement for malignant hilar biliary obstruction

Management of acute cholangitis as a result of occlusion from a self‐expandable metallic stent in patients with malignant distal and hilar biliary obstructions

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