Kawamoto H, Tsutsumi K, Fujii M, Harada R, Kato H, Hirao K, Kurihara N, Nakanishi T, Mizuno O, Ishida E, Ogawa T, Fukatsu H, Sakaguchi K. Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos).
Gastrointest Endosc 2007;
66:1030-7. [PMID:
17963891 DOI:
10.1016/j.gie.2007.06.055]
[Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/30/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND
In view of the recent advancement in endoscopic devices for biliary endoscopic intervention, the expert endoscopist can address complex morbidity. However, endoscopic 3-branched partial stent-in-stent deployment of metallic stents (MS) in patients with malignant hilar biliary stricture is technically demanding.
OBJECTIVES
To evaluate the efficacy and safety of endoscopic 3-branched partial stent-in-stent deployment of MS.
DESIGN
Case study.
SETTING
Gastroenterological Center, Okayama University Hospital.
PATIENTS
Nine consecutive patients (mean age 63 years, range 52-84 years, mean follow-up period 5 months) with malignant hilar biliary stricture were enrolled. They had cytologically or histologically proven unresectable biliary-tract carcinoma with hilar biliary stricture type IIIa or IV according to Bismuth's classification.
INTERVENTIONS
Endoscopic 3-branched partial stent-in-stent deployment of MS in hilar biliary strictures by using a JOSTENT SelfX stent.
MAIN OUTCOME MEASUREMENTS
The success rate of the procedure, stent patency time, reinterventions, and complications.
RESULTS
Endoscopic 3-branched partial stent-in-stent deployment was successfully accomplished in all cases. The MS became obstructed in 3 cases (33%), mean 1.5 months, range 1.4 to 2.7 months. However, no MS obstruction occurred in the other 6 patients (67%), mean 11 months, range 4.7 to 16.4 months. In the obstructed cases, the deployment of 2 or 3 tube stents was completed successfully. One case of cholecystitis was observed as a short-term complication.
LIMITATION
The small number of cases.
CONCLUSIONS
Endoscopic 3-branched partial stent-in-stent deployment of a JOSTENT SelfX stent was effective in selected patients with high-grade malignant hilar biliary stricture.
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