Unilateral placement of metallic stents for malignant hilar obstruction: A prospective study

Palma, Giovanni Domenico De; Pezzullo, Angelo Maria; Rega, Michele F.; Persico, Marcello; Patrone, Francesco; Mastantuono, Luigi; Persico, Giovanni

doi:10.1067/mge.2003.310

Cited by 170 publications

(145 citation statements)

References 9 publications

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“…The overall drainage response rate in this study was 63%, but the response rate was 89% for the subjects who met the abovementioned criteria. These subjects had a better response rate than those in earlier studies (49%-87%) [3,[13][14][15][16][17][18][19] . In addition, of the 29 patients who did not respond to the initial drainage, 24 (83%) did not meet the above criteria.…”

Section: Discussionmentioning

confidence: 54%

“…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%

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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: Discussionmentioning

confidence: 54%

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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“…By contrast, the bile duct consists of isolated segments and not all of the bile ducts come together, so only an uncovered metallic stent may achieve full biliary drainage. However, as a result of tumor ingrowth or overgrowth, the insertion of an uncovered metallic stent alone cannot yield a satisfactory stent patency or patient survival time (11)(12).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

et al. 2015

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Abstract. Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P= 0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P= 0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time.

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“…Generally, if both lobes are imaged with contrast during cholangiography bilateral stenting reduces the potential sequelae of cholangitis in contaminated but undrained areas. If contrast does not contaminate both sides then unilateral stenting should be sufficient [10][11][12][13] .…”

Section: A) )mentioning

confidence: 99%

“…Recent reports describe the utility of magnetic resonance agnetic resonance cholangiopancreatography (�RCP) or C� imaging to guide (�RCP) or C� imaging to guide �RCP) or C� imaging to guide ) or C� imaging to guide or C� imaging to guide selection of the target lobe for subsequent endoscopic stenting, often without use of contrast [12,13] .…”

Section: A) )mentioning

confidence: 99%

Endoscopic approach to malignant strictures at the hepatic hilum

Palma¹

2007

WJG

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Hilar tumors have proven to be a challenge to treat and manage because of their poor sensitivity to conventional therapies and our inability to prevent or to detect early tumor formation. Endoscopic stent drainage has been proposed as an alternative to biliary-enteric bypass surgery and percutaneous drainage to palliate malignant biliary obstruction. Prosthetic palliation of patients with malignant hilar stenoses poses particular difficulties, especially in advanced lesions (type Ⅱ lesions or higher). The risk of cholangitis after contrast injection into the biliary tree in cases where incomplete drainage is achieved is well known. The success rate of plastic stent insertion is around 80% in patients with proximal tumors. Relief of symptoms can be achieved in nearly all patients successfully stented.

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Unilateral placement of metallic stents for malignant hilar obstruction: A prospective study

Cited by 170 publications

References 9 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

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Endoscopic approach to malignant strictures at the hepatic hilum

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