title: Selective intrahepatic duct cannulation by using a triple-lumen catheter for endoscopic bilateral stenting in hilar cholangiocarcinoma.
abstract: BACKGROUND
  Selective cannulation of the intrahepatic duct is essential for endoscopic management of hilar cholangiocarcinoma, but it can be very difficult to achieve. Preexisting methods are sometimes time consuming and have limited success.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a triple-lumen catheter for selective cannulation in the intrahepatic ducts of patients with hilar cholangiocarcinoma.
  
  
  METHODS
  Retrospective analysis of a prospective database.
  
  
  METHODS
  Tertiary-care referral university hospital.
  
  
  METHODS
  This study involved 58 patients with unresectable hilar cholangiocarcinoma (Bismuth types II-IV), in whom attempts were made to insert bilateral stents endoscopically.
  
  
  METHODS
  After conventional cannulation methods failed, selective cannulation with a triple-lumen catheter was tried.
  
  
  METHODS
  Selective cannulation of the left or right intrahepatic duct.
  
  
  RESULTS
  With the triple-lumen catheter, the rates of successful selective intrahepatic duct cannulation increased from 97% (56/58 patients) to 100% (58/58 patients) in the first stent (Y stent) placement site and from 78% (45/58 patients) to 91% (53/58 patients) in the second (contralateral stent) placement site. Selective cannulation with the triple-lumen catheter was achieved in 10 of 15 patients (67%) in whom conventional methods failed. When the triple-lumen catheter was used, the success rate of guidewire insertion into the bilateral intrahepatic ducts was increased from 74% (43 patients) to 91% (53 patients).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  Use of the triple-lumen catheter appears to be an effective method for selective cannulation of intrahepatic ducts. It can be considered as a valuable method for selective cannulation in patients with hilar cancer in whom conventional methods have failed.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, National R&D Center for Hepatobiliary Cancer, Yangsan-si, Gyeongsangnam-do, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D002404:Catheterization / Q000295:instrumentation*; D018281:Cholangiocarcinoma / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D002761:Cholangitis / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D041781:Jaundice, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome