Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction
Received 22 July 2008; accepted 6 August 2009. published online 30 November 2009.
Background
Placement of biliary stents is effective for palliation of unresectable hilar malignant biliary obstruction. However, when bilateral self-expandable metal stents (SEMSs) are used, placement can be technically challenging. In many studies, side-by-side placement is performed, although it is unclear whether this is the most anatomical and functional approach.
Objective
We sought to assess the technical feasibility and effectiveness of deploying bilateral SEMSs with a stent-within-stent approach using commercially available stents with a large cell width.
Design
Retrospective study.
Setting
Tertiary care medical center.
Patients
Patients with malignant biliary hilar obstruction referred for endoscopic palliation of obstructive jaundice.
Main Outcome Measurements
Technical success, ie, successful bilateral SEMS placement across the stricture; functional success, ie, decrease in pretreatment bilirubin level; early and late complications; and stent patency.
Results
Bilateral biliary drainage was attempted and successfully established in 21 patients with malignant hilar obstruction (15 men, 6 women; mean age 63.7 [standard deviation 13.9] years), resulting in clinical improvement of obstructive symptoms. Median follow-up was 6.14 months (interquartile range 3.5-9.5 months). There were 1 (5%) early and 7 (33%) late stent occlusions that required endoscopic reintervention. The 30-day mortality rate was 10% (2 deaths).
Limitations
Retrospective study of a series of cases treated at a tertiary care center by expert endoscopists.
Conclusions
This simple technique was performed by using an open-cell expandable metal stent is technically feasible and easy and allows bilateral placement of SEMSs in patients with unresectable hilar malignancy.
Current affiliations: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
Reprint requests: Todd H. Baron, MD, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine 200 First Street SW, Charlton 8, Rochester, MN 55905.
DISCLOSURE: The following author disclosed a financial relationship relevant to this publication: T.H. Baron is a consultant to and on the speakers' bureau of ConMed. The other author disclosed no financial relationships relevant to this publication.
ABSTRACT