Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos).
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.
Kawamoto
Hirofumi
H
Department of Gastroenterology and Hepatology, Okayama University Graduates School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
Tsutsumi
Koichiro
K
Fujii
Masakuni
M
Harada
Ryo
R
Kato
Hironari
H
Hirao
Ken
K
Kurihara
Naoko
N
Nakanishi
Takashi
T
Mizuno
Osamu
O
Ishida
Etsuji
E
Ogawa
Tsuneyoshi
T
Fukatsu
Hirotoshi
H
Sakaguchi
Kohsaku
K
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