title: Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos).
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.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of endoscopic 3-branched partial stent-in-stent deployment of MS.
  
  
  METHODS
  Case study.
  
  
  METHODS
  Gastroenterological Center, Okayama University Hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Endoscopic 3-branched partial stent-in-stent deployment of MS in hilar biliary strictures by using a JOSTENT SelfX stent.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduates School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Masakuni
authors.initials: M
authors.lastname: Fujii
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Ken
authors.initials: K
authors.lastname: Hirao
authors.forename: Naoko
authors.initials: N
authors.lastname: Kurihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Osamu
authors.initials: O
authors.lastname: Mizuno
authors.forename: Etsuji
authors.initials: E
authors.lastname: Ishida
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Fukatsu
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000601:surgery / Q000628:therapy*; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D016145:Endoscopy, Digestive System / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D020535:Video-Assisted Surgery