Endoscopic deployment of multiple JOSTENT SelfX is effective and safe in treatment of malignant hilar biliary strictures.
OBJECTIVE
For the treatment of unresectable biliary tract carcinoma with hilar biliary stricture, antitumor therapy and biliary stenting should be addressed in terms of prolonged survival with a good quality of life. However, the endoscopic management of malignant hilar biliary strictures is difficult even for an expert endoscopist. We evaluated the efficacy and safety of the endoscopic deployment of multiple JOSTENT SelfX units in patients with hilar biliary strictures treated with or without chemotherapy.


METHODS
Between November 2003 and December 2006, endoscopic deployment of multiple JOSTENT SelfX units in hilar biliary strictures by using a partial stent-in-stent procedure was performed on 41 consecutive patients with primary cholangiocarcinoma (n = 34) and gallbladder carcinoma (n = 7) at a gastroenterologic center of Okayama University Hospital. Thirty-three patients were treated with gemcitabine (n = 25) or S-1 (n = 8).


RESULTS
Metallic stent deployment was successfully accomplished in all cases via only endoscopic procedures. During the follow-up period (mean, 210 days), mean patency time was 150 days, and metallic stent obstruction occurred in 15 cases (37%). Although a repeat intervention was required in all metallic stent obstructed cases, the deployment of the second metallic or plastic stent was completed successfully. The remaining 26 cases (63%) required no interventions. The median overall survival period was only 235 days. However, that of the patients receiving chemotherapy was 392 days.


CONCLUSIONS
Endoscopic partial stent-in-stent deployment with multiple JOSTENT SelfX prostheses is effective and safe for the treatment of malignant hilar biliary stricture even in patients receiving chemotherapy.
Kawamoto
Hirofumi
H
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama City, Japan. h-kawamo@md.okayama-u.ac.jp
Tsutsumi
Koichiro
K
Harada
Ryo
R
Fujii
Masakuni
M
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; D000497:Alloys; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D018281:Cholangiocarcinoma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D000497:Alloys; D000970:Antineoplastic Agents; C013616:nitinol