Selective intrahepatic duct cannulation by using a triple-lumen catheter for endoscopic bilateral stenting in hilar cholangiocarcinoma.
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.
Kim
Ji Young
JY
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.
Kang
Dae Hwan
DH
Choi
Cheol Woong
CW
Kim
Hyung Wook
HW
Park
Su Bum
SB
Kim
Dong Uk
DU
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