title: Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction.
abstract: BACKGROUND
  Placement of biliary stents is effective for palliation of unresectable hilar malignant biliary obstruction. However, when bilateral self-expandable metal stents (SEMSs) are used, placement can be technically challenging. In many studies, side-by-side placement is performed, although it is unclear whether this is the most anatomical and functional approach.
  
  
  OBJECTIVE
  We sought to assess the technical feasibility and effectiveness of deploying bilateral SEMSs with a stent-within-stent approach using commercially available stents with a large cell width.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  Patients with malignant biliary hilar obstruction referred for endoscopic palliation of obstructive jaundice.
  
  
  METHODS
  Technical success, ie, successful bilateral SEMS placement across the stricture; functional success, ie, decrease in pretreatment bilirubin level; early and late complications; and stent patency.
  
  
  RESULTS
  Bilateral biliary drainage was attempted and successfully established in 21 patients with malignant hilar obstruction (15 men, 6 women; mean age 63.7 [standard deviation 13.9] years), resulting in clinical improvement of obstructive symptoms. Median follow-up was 6.14 months (interquartile range 3.5-9.5 months). There were 1 (5%) early and 7 (33%) late stent occlusions that required endoscopic reintervention. The 30-day mortality rate was 10% (2 deaths).
  
  
  CONCLUSIONS
  Retrospective study of a series of cases treated at a tertiary care center by expert endoscopists.
  
  
  CONCLUSIONS
  This simple technique was performed by using an open-cell expandable metal stent is technically feasible and easy and allows bilateral placement of SEMSs in patients with unresectable hilar malignancy.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors: Prabhleen
authors: P
authors: Chahal
authors: Todd H
authors: TH
authors: Baron
mesh_terms: D000368:Aged; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004067:Digestive System Neoplasms / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome