Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study.
BACKGROUND
Palliation of patients with malignant hilar stenoses, especially advanced lesions, by stent insertion poses particular difficulties. This study assessed the efficacy of endoscopically inserted unilateral metallic stents for complex malignant hilar obstruction.


METHODS
A prospective, uncontrolled, single-center study was conducted by using a cohort of 61 patients with malignant hilar obstruction. A single, unilateral metallic stent was inserted across the stricture into the duct that technically was easiest to access. Patients were evaluated 1 month after stent placement and, thereafter, every 3 months.


RESULTS
Successful stent insertion was achieved in 59 of 61 (96.7%) patients. In 3 of 61 (4.9%) cases, stent malfunction occurred. Successful drainage was achieved in 59 of 61 (96.7%) patients and complete resolution of jaundice in 86% of cases. Early complications included cholangitis in 3 of 61 (4.9%) patients and stent occlusion in 2 of 61 (3.2%). Late stent occlusion occurred in 14 of 61 (22.9%) patients, including 10 (16.3%) cases of cholangitis and one of liver abscess. Median stent patency was 169 days. Median patient survival was 140 days.


CONCLUSIONS
Unilateral metallic stent insertion is safe, feasible, and achieves adequate drainage in the great majority of patients with nonresectable hilar cholangiocarcinoma.
De Palma
Giovanni D
GD
Department of Surgery and Advanced Technologies, Section of Diagnostic and Therapeutic Endoscopy, University of Naples Federico II, School of Medicine, Italy.
Pezzullo
Angelo
A
Rega
Maria
M
Persico
Marcello
M
Patrone
Francesco
F
Mastantuono
Luigi
L
Persico
Giovanni
G
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000150:complications* / Q000401:mortality / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
D008670:Metals