title: Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction.
abstract: BACKGROUND
  Anomalous pancreaticobiliary junction (APBJ) is associated with pancreaticobiliary cancer. Limited data are available on endoscopic biliary drainage for unresectable malignant biliary obstruction with APBJ. This study evaluated the efficacy and safety of self-expandable metallic stents (EMSs) for the management of malignant biliary obstruction with APBJ.
  
  
  METHODS
  Between 1993 and 2005, 324 patients with unresectable malignant biliary obstruction underwent insertion of an EMS. Six of these patients with concomitant APBJ constituted the subjects of this study. Early (</=30 days after EMS insertion) and late (>30 days after EMS insertion) stent-related complications and stent patency were evaluated in these six patients.
  
  
  RESULTS
  The cause of biliary obstruction was gallbladder cancer in four patients and pancreatic cancer in two patients. Uncovered EMSs were inserted across the common channel without performance of a biliary sphincterotomy. The diameter of the uncovered EMS used was based on the diameter of the common channel. For all six patients, endoscopic biliary drainage was successful, and their jaundice subsided steadily. None of the six patients experienced early complications, including acute pancreatitis. The mean stent-related complication-free period was 163 days. Stent occlusion caused by tumor ingrowth occurred in two patients. Acute cholangitis and cholecystitis were observed in one patient each.
  
  
  CONCLUSIONS
  Uncovered EMSs are effective for palliation of unresectable malignant biliary obstruction in patients who have APBJ without increasing the risk of stent-related early complications.
authors: Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. kogureh-tky@umin.ac.jp
authors: H
authors: H
authors: Kogure
authors: T
authors: T
authors: Tsujino
authors: H
authors: H
authors: Yagioka
authors: T
authors: T
authors: Sasaki
authors: Y
authors: Y
authors: Nakai
authors: K
authors: K
authors: Hirano
authors: N
authors: N
authors: Sasahira
authors: H
authors: H
authors: Isayama
authors: M
authors: M
authors: Tada
authors: T
authors: T
authors: Kawabe
authors: M
authors: M
authors: Omata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D002779:Cholestasis / Q000209:etiology* / Q000628:therapy*; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome
references: Gastrointest Endosc. 2005 Nov;62(5):742-8
references: 16246690
references: Gastrointest Endosc. 2005 Apr;61(4):528-33
references: 15812404
references: Gut. 1989 Aug;30(8):1132-5
references: 2475392
references: Gastrointest Endosc. 1999 Nov;50(5):623-7
references: 10536316
references: Lancet. 1992 Dec 19-26;340(8834-8835):1488-92
references: 1281903
references: Int Surg. 1995 Jul-Sep;80(3):215-7
references: 8775605
references: Gut. 2004 May;53(5):729-34
references: 15082593
references: Am J Gastroenterol. 1987 Jan;82(1):20-4
references: 3799576
references: Gastrointest Endosc. 2003 Feb;57(2):178-82
references: 12556780
references: J Hepatobiliary Pancreat Surg. 2000;7(6):551-5
references: 11180886
references: Br J Surg. 1993 May;80(5):622-4
references: 8518907
references: Cancer. 1979 Sep;44(3):1134-41
references: 383269
references: Hepatogastroenterology. 2001 Nov-Dec;48(42):1767-9
references: 11813620
references: Gastrointest Endosc. 2006 Oct;64(4):522-9
references: 16996343
references: Clin Gastroenterol Hepatol. 2006 Sep;4(9):1148-53
references: 16904950
references: Gastroenterology. 1985 Dec;89(6):1258-65
references: 4054518
references: Lancet. 1994 Dec 17;344(8938):1655-60
references: 7996958
references: Gastrointest Endosc. 2002 Mar;55(3):366-70
references: 11868010
references: Gastrointest Endosc. 2003 Apr;57(4):541-5
references: 12665766
references: Hepatogastroenterology. 2001 Mar-Apr;48(38):382-6
references: 11379314
references: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references: 2070995
references: Int Surg. 1995 Jan-Mar;80(1):61-4
references: 7657495
references: Hepatogastroenterology. 1998 Nov-Dec;45(24):2016-9
references: 9951856
references: J Hepatobiliary Pancreat Surg. 1999;6(3):218-22
references: 10526055
references: Gastrointest Endosc. 1998 Aug;48(2):184-9
references: 9717785
references: J Hepatobiliary Pancreat Surg. 1998;5(1):113-6
references: 9683764
references: J Hepatobiliary Pancreat Surg. 2002;9(1):45-54
references: 12021897