Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction.
OBJECTIVE
The extent of liver drainage for palliative treatment of malignant hilar biliary obstruction is controversial. The aim of this study was to compare endoscopic unilateral versus bilateral drainage in patients with malignant hilar biliary obstruction using a self-expanding metal stent (SEMS).


METHODS
We carried out a retrospective review of 46 consecutive patients with malignant hilar biliary obstruction who were treated by endoscopic biliary drainage using SEMS between 1997 and 2005. Unilateral metal stenting (group A) was performed in 17 patients between 1997 and 2000, and bilateral metal stenting (group B) was performed in 29 patients between 2001 and 2005. The successful stent insertion, successful drainage, early complications, late complications, stent patency, and survival rate for groups A and B were evaluated and compared retrospectively.


RESULTS
There were no significant differences between the two groups in successful stent insertion (100% vs 90%, group A vs B, respectively), successful drainage (100% vs 96%), early complications (0% vs 10%), or late complications (65% vs 54%). Cumulative stent patency was significantly better in group B than in group A (P = 0.009). In cases of cholangiocarcinoma, cumulative stent patency was significantly better in group B than in group A (P = 0.009), whereas there were no inter-group differences for gallbladder carcinoma. Cumulative survival did not differ significantly between the groups.


CONCLUSIONS
Endoscopic bilateral drainage using SEMS for malignant hilar biliary obstruction is more effective than unilateral drainage in terms of cumulative stent patency, especially in cases of cholangiocarcinoma.
Naitoh
Itaru
I
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Ohara
Hirotaka
H
Nakazawa
Takahiro
T
Ando
Tomoaki
T
Hayashi
Kazuki
K
Okumura
Fumihiro
F
Okayama
Yasutaka
Y
Sano
Hitoshi
H
Kitajima
Yasuhiro
Y
Hirai
Masaaki
M
Ban
Tessin
T
Miyabe
Katsuyuki
K
Ueno
Koichiro
K
Yamashita
Hiroaki
H
Joh
Takashi
T
D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002404:Catheterization; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D008670:Metals