Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2015; 3(10): 887-893
Published online Oct 16, 2015. doi: 10.12998/wjcc.v3.i10.887
New tapered metallic stent for unresectable malignant hilar bile duct obstruction
Yuji Sakai, Toshio Tsuyuguchi, Takao Nishikawa, Harutoshi Sugiyama, Reina Sasaki, Dai Sakamoto, Yuto Watanabe, Masato Nakamura, Shin Yasui, Rintaro Mikata, Osamu Yokosuka
Yuji Sakai, Toshio Tsuyuguchi, Takao Nishikawa, Harutoshi Sugiyama, Reina Sasaki, Dai Sakamoto, Yuto Watanabe, Masato Nakamura, Shin Yasui, Rintaro Mikata, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba City 260-8670, Japan
Author contributions: Sakai Y, Tsuyuguchi T and Yokosuka O were responsible for the study design, data analysis, and manuscript preparation; Sakai Y wrote the paper; Sakai Y, Tsuyuguchi T, Nishikawa T, Sugiyama H, Sasaki R, Watanabe Y, Yasui S and Mikata R performed endoscopic treatment; Sakamoto D and Nakamura M were responsible for data collection.
Institutional review board statement: This study was conducted under approval of our ethical committee, and was registered as prospective clinical trial.
Clinical trial registration statement: UMIN Clinical Trial Registry (UMIN000004758).
Informed consent statement: All the treatment procedures were performed after obtaining the informed consent in writing from the patients.
Conflict-of-interest statement: The authors have no other disclosures.
Data sharing statement: I share data in the group of us.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuji Sakai, MD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City 260-8670, Japan. sakai4754@yahoo.co.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: April 6, 2015
Peer-review started: April 8, 2015
First decision: June 4, 2015
Revised: July 12, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: October 16, 2015
Processing time: 193 Days and 4.4 Hours
Abstract

AIM: To examine the usefulness of a new tapered metallic stent (MS) in patients with unresectable malignant hilar bile duct obstruction.

METHODS: This new tapered MS was placed in 11 patients with Bismuth II or severer unresectable malignant hilar bile duct obstruction, as a prospective study. The subjects were six patients with bile duct carcinoma, three with gallbladder cancer, and two with metastatic bile duct obstruction. Stenosis morphology was Bismuth II: 7, IIIa: 3, and IV: 1. UMIN Clinical Trial Registry (UMIN000004758).

RESULTS: MS placement was 100% (11/11) successful. There were no procedural accidents. The mean patency period was 208.401 d, the median survival period was 142.000 d, and the mean survival period was 193.273 d. Occlusion rate was 36.4% (4/11); the causes of occlusion were ingrowth and overgrowth in 2 patients each, 18.2%, respectively. Patients with occlusion underwent endoscopic treatment one more time and all were treatable.

CONCLUSION: The tapered MS proved useful in patients with unresectable malignant hilar bile duct obstruction because it provided a long patency period, enabled re-treatment by re-intervention, and no procedural accidents occurred.

Keywords: Malignant hilar bile duct obstruction; Metallic stent; Tapered metallic stent

Core tip: Placement of a tapered metallic stent in patients with unresectable malignant hilar bile duct obstruction proved useful because it allowed a longer patency period without procedural accidents.