Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents

Freeman, Martin L.; Overby, Carol

doi:10.1067/mge.2003.292

Cited by 184 publications

(128 citation statements)

References 31 publications

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“…Recent reports describe the utility of MRCP or CT imaging to guide selection of the target lobe for subsequent endoscopic stenting [7][8][9] . Constrast-free biliary decompression has been performed and previously reported with duodenoscopes, US, and EUS guidance [16][17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Palma

Lombardi²,

Rega³

et al. 2007

WJG

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AIM:To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS:Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/ guiding catheter by a pusher tube system. RESULTS:Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION:This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach www.wjgnet.com with the standard procedure is needed to confirm the findings of the present study.

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Section: Discussionmentioning

confidence: 99%

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Palma

Lombardi²,

Rega³

et al. 2007

WJG

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“…[27][28][29][30][31] MDCT is also useful for evaluating complications, such as ascites and gastrointestinal obstruction, caused by tumor dissemination.…”

Section: Percutaneous Transhepatic Biliary Drainagementioning

confidence: 99%

Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist

Sato

Inaba

Hara

et al. 2016

Int J Gastrointest Interv

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A B S T R A C TIn the palliative setting, the necessity of biliary drainage of both liver lobes for malignant hilar biliary obstruction remains controversial. However, bilateral biliary drainage is a reasonable option to prevent cholangitis of the undrained lobe and to preserve liver function during the course of chemotherapy. Bilateral biliary drainage can be accomplished by the percutaneous or endoscopic placement of multiple self-expandable metallic stents (SEMS). Although SEMS placement via bilateral (multiple) percutaneous routes is technically simple, multiple percutaneous transhepatic biliary drainage (PTBD) may lead to additional morbidity. SEMS placement via a single percutaneous route is a useful method; however, negotiation of a guidewire into the contralateral bile duct is occasionally impossible if the hilar angle between the right hepatic duct and left hepatic duct is acute. Percutaneous dual SEMS placement is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-byside technique. In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. The side-to-end technique is also useful for multiple SEMS placement. In the future, the combination of percutaneous intervention and endoscopic ultrasonography-guided procedures may be effective in the management of malignant hilar biliary obstruction.

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“…If occlusion did not occur during a patient's life time, the patency period was considered equal to the survival period but censored. Jaundice recurrence was defined as the symptom of jaundice recurred after it had subsided and met one of the followings: (1) cholangiography, CT or US demonstrated redilation of bile duct, (2) combined serum bilirubin concentration/total serum bilirubin concentration 35% (Figure 2). …”

Section: Follow-upmentioning

confidence: 99%

“…Self-expanding metal stent, due to its minimal invasion, low risk of migration and efficient bile drainage, has been widely used for management of malignant obstructive jaundice (MOJ) [1][2][3][4][5][6][7][8][9][10][11] . Although self-expanding metal stent seems to be the first choice in the palliation of MOJ, high rates of stent occlusion, which were mainly caused by tumor ingrowth or overgrowth, usually lead to jaundice recurrence [12,13] .…”

Section: Introductionmentioning

confidence: 99%

HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

Chen¹

2004

WJG

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AIM:To determine the feasibility and safety of intraluminal brachytherapy in treatment of malignant obstructive jaundice (MOJ) and to evaluate the clinical effect of intraluminal brachytherapy on stent patency and patient survival. METHODS:Thirty-four patients with MOJ were included in this study. Having biliary stent placed, all patients were classified into intraluminal brachytherapy group (group A, n = 14) and control group (group B, n = 20) according to their own choice. Intraluminal brachytherapy regimen included:

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Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents

Cited by 184 publications

References 31 publications

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist

HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

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Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents

Cited by 184 publications

References 31 publications

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Contrast-free endoscopic stent insertion in malignant biliary obstruction

Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist

HDR-192Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice

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HDR-¹⁹²Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice