Usefulness of slimmer and open-cell-design stents for endoscopic bilateral stenting and endoscopic revision in patients with hilar cholangiocarcinoma (with video).
BACKGROUND
Although endoscopic bilateral metal stenting using a "stent-in-stent" method is currently used to treat patients with unresectable hilar cholangiocarcinoma, this method has limited application in cases of tight strictures or endoscopic revision in case of tumor recurrence, especially on the first stent (initial Y stent placed) side.


OBJECTIVE
To evaluate the clinical efficacy of bilateral metal stenting with the use of a slimmer (7F), open-cell-design stent.


METHODS
Prospective, uncontrolled, single center.


METHODS
Tertiary referral university hospital.


METHODS
This study involved 34 patients with unresectable hilar cholangiocarcinoma (Bismuth type II-IV).


METHODS
Endoscopic bilateral metal stenting using a stent-in-stent method was performed. First, a Y stent with a central, wide-open mesh was inserted, then a Zilver stent, with a preloaded delivery system that is slimmer (7F) than those (7.5-8.5F) of conventional stents, was placed into the contralateral hepatic duct through the central portion of the Y stent. The Zilver stent has an open-cell design, and it can be dilated easily. Thus, revision with bilateral plastic stents was tried in cases of stent obstruction.


METHODS
Technical success, functional success, complications, and revision method.


RESULTS
Technical success (bilateral stenting using Y and Zilver stents) was achieved in 29 of 34 (85.3%) patients. Functional success was noted in 29 of the 29 (100.0%) patients who received bilateral stenting. Early complications such as pancreatitis and cholecystitis occurred in 3 (10.3%) patients. Late complications occurred in 11 (37.9%) patients. Cholecystitis, which occurred in 2 patients, was managed by percutaneous transhepatic gallbladder drainage. Stent obstruction by tumor ingrowth or overgrowth occurred in 9 of 29 (31.0%) patients. These patients were managed by placement of bilateral plastic stents (4 of 9), percutaneous transhepatic biliary drainage (4 of 9), and a combined method (1 of 9). Of the 5 patients in whom endoscopic revision was attempted, 4 (80%) were managed endoscopically with bilateral plastic stents.


CONCLUSIONS
Small number of patients, uncontrolled study.


CONCLUSIONS
A slimmer (7F), open-cell-design stent is effective in endoscopic bilateral stenting for advanced hilar cholangiocarcinoma and endoscopic revision in case of tumor recurrence.
Kim
Jeong Yeol
JY
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Yangsan, Korea.
Kang
Dae Hwan
DH
Kim
Hyung Wook
HW
Choi
Cheol Woong
CW
Kim
Il Du
ID
Hwang
Jong Ho
JH
Kim
Dong Uk
DU
Eum
Jae Sup
JS
Bae
Yong Mock
YM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000628:therapy*; D016145:Endoscopy, Digestive System; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents / Q000009:adverse effects
D008670:Metals