Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction

Inatomi, Osamu; Bamba, Shigeki; Shioya, Makoto; Mochizuki, Yosuke; Ban, Hiromitsu; Tsujikawa, Tomoyuki; Saito, Yasuharu; Andoh, Akira; Fujiyama, Yoshihide

doi:10.1186/1471-230x-13-31

Cited by 38 publications

(59 citation statements)

References 32 publications

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“…Endoscopic sphincterotomy for above stent placement becomes obsolete even if multiple stents are planned 15 . For the maintenance of the above stent device, there are sometimes difficulties in its retrieval; however, a string can be attached to this device to overcome this concern 15 16 30 . The above stent device can be easily removed and reduces the risk of cholangitis.…”

Section: Discussionmentioning

confidence: 99%

Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

et al. 2016

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Background and study aims: Neoadjuvant chemotherapy (NAC) may lead to a successful margin-negative resection in patients with initially unresectable locally advanced Klatskin tumor (IULAKT). Use of removable plastic stents is preferable for the safe implementation of NAC in patients with IULAKT to reduce the risk of recurrent cholangitis. Our aim was to evaluate the efficacy associated with the use of plastic stents placed across the stenosis and above the papilla (above stent) during NAC. Patients and methods: In this study, we stratified the patients into two groups chronologically with respect to the period of stent placement: above stent group (n = 17) and across stent group (n = 23) (plastic stent across the sphincter of Oddi). Results: The median stent patency period was 99 days in the above stent group and 31 days in the across stent group (P < 0.0001). The number of stents (P = 0.017) and the rate of emerging undrained cholangitis areas (P = 0.025) were significantly reduced in the above stent group than the counterpart. Regarding time to recurrent biliary obstruction, the above stent group had a longer duration than the across stent group (log rank test, P = 0.004). Length of hospital stay was significantly shorter for the above stent group than the across stent group (P = 0.0475). Multivariate analysis revealed that above stent placement (odds ratio = 33.638, P = 0.0048) was significantly associated with stent patency over a period of 90 days. Conclusions: Above stent placement should be considered for the relief of biliary obstruction and potentially reduces the cost for patients with IULAKT scheduled to receive NAC.

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Section: Discussionmentioning

confidence: 99%

Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

et al. 2016

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“…14 Moreover, in a retrospective study on humans by Inatomi et al, suprapapillary PS placement had more favorable outcomes than transpapillary PS placement (median patency period: 142 for iPSs vs. 32 for transpapillary PSs, p=0.04 on log rank test). 10 This is the first study evaluating outcomes of suprapapillary PS versus suprapapillary MS placement. However, three retrospective studies of iPS without comparison to MS reported median patency periods of 136 days, 9 142 days, 10 and 190 days.…”

Section: Discussionmentioning

confidence: 99%

“…10 This is the first study evaluating outcomes of suprapapillary PS versus suprapapillary MS placement. However, three retrospective studies of iPS without comparison to MS reported median patency periods of 136 days, 9 142 days, 10 and 190 days. 8 In our study, iPSs had significantly longer median patency periods with no unfavorable outcomes in terms of clinical efficacy, short-and long-term adverse events, or survival period.…”

Section: Discussionmentioning

confidence: 99%

“…In a well-designed retrospective study by Inatomi et al patients with lower Bismuth levels (types I and II) were included and appeared to be associated with stent patencies of less than 60 days. 10 As suggested in an RCT by Pedersen et al in which suprapapillary and transpapillary PSs (using a hybrid endoscopic-percutaneous technique) were compared for treating obstructions of the extrahepatic (not perihilar) bile duct, 15 iPSs might not be favorable for non-perihilar strictures. Strictures in the non-hilar-involving bile duct can be related to shorter functional periods of iPSs due to stent location instability, which can cause wedging of the distal (duodenal side) end to the lower narrow bile duct.…”

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confidence: 99%

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Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study

et al. 2020

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Background/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions. Methods: For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated. Results: There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0-1,186 days) for iPSs and 209 days (127-291 days) for MSs, showing a significant difference (p=0.008). Conclusions: Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option. Clin Endosc 2020 Mar 4. [Epub ahead of print]

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“… 26 , 27 , 28 In addition, reflux of duodenal content into the biliary tract may be a contributing factor, as prior studies have shown that positioning above the papilla/sphincter of Oddi may improve patency for both plastic and metallic prostheses. 29 , 30 , 31 , 32 In addition, those required surgical tumor debulking had shorter stent patency at multivariate analysis, perhaps due to inflammatory chemokines produced by the tumor. 33 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Drainage of >50% of Liver in Malignant Hilar Biliary Obstruction Using Metallic or Fenestrated Plastic Stents

Kerdsirichairat

Arain

Attam

et al. 2017

Clinical and Translational Gastroenterology

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Objectives:Endoscopic drainage of complex hilar tumors has generally resulted in poor outcomes. Drainage of >50% of liver volume has been proposed as optimal, but not evaluated using long multifenestrated plastic stents (MFPS) or self-expanding metal stents (SEMS). We evaluated outcomes of endoscopic drainage of malignant hilar strictures using optimal strategy and stents, and determined factors associated with stent patency, survival, and complications.Methods:Cross-sectional study was conducted at an academic center over 5 years. MFPS (10 French or 8.5 French) or open-cell SEMS were used for palliation of unresectable malignant hilar strictures, with imaging-targeted drainage of as many sectors as needed to drain >50% of viable liver volume. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan–Meier analysis.Results:77 patients with malignant hilar biliary strictures (median Bismuth IV) underwent targeted stenting (41 MFPS and 36 SEMS). Comparing MFPS vs. SEMS, technical success (95.1 vs. 97.2%, P=0.64), clinical success (75.6 vs. 83.3%, P=0.40), frequency of multiple stents (23/41 vs. 25/36, P=0.19), survival and adverse events were similar, but stent patency was significantly shorter (P<0.0001). Factors associated with survival were Karnofsky score and serum bilirubin level at presentation. Outcomes were independent of Bismuth class with acceptable results in Bismuth III and IV.Conclusions:Endoscopic biliary drainage with MFPS or open-cell SEMS targeting >50% of viable liver resulted in effective palliation in patients with complex malignant hilar biliary strictures. Patency was shorter in the MFPS group, but similar survival and complications were found when comparing MFPS and SEMS group.

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Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction

Cited by 38 publications

References 32 publications

Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study

Endoscopic Drainage of >50% of Liver in Malignant Hilar Biliary Obstruction Using Metallic or Fenestrated Plastic Stents

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