title: Triple metallic stenting in hilar malignant biliary obstructions.
abstract: OBJECTIVE
  To research the effects of triple stenting on primary patency rates and on clinical and biochemical findings in patients with high-level malignant biliary obstruction.
  
  
  METHODS
  We analyzed eight patients who had undergone triple stenting for hilar malignant biliary obstruction, mainly with the percutaneous approach, between January 2009, and September 2009. Pre-interventional bilirubin levels and the existence of pruritus or cholangitis were recorded. Patients were examined 15 days and three months post-intervention. Procedure-related mortality and 30-day mortality rates were recorded. Changes in the serum bilirubin levels, pruritis and cholangitis were examined. Primary patency rates were calculated with the Kaplan-Meier method.
  
  
  RESULTS
  Pruritis and cholangitis improved within 15 days. There was a significant decrease in serum bilirubin levels, which were very near to normal limits. Two patients died: one in the fourth month and the other in the eighth month. The mean patency rate was 179±18.81 days. There were no procedure-related or 30-day mortalities in the study group.
  
  
  CONCLUSIONS
  Triple metallic stenting did not significantly improve primary patency rates in hilar malignant biliary obstructions. However, the beneficial effects of triple stenting included the rapid improvement in clinical and biochemical signs in select patients. Triple stenting will be beneficial in preventing isolation that might cause cholangitis. Malignant biliary obstruction in patients with a trifurcation anomaly in the hilar region may necessitate triple stenting.
authors.affiliation: Radiology Clinic, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey. fkucukay@hotmail.com
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Küçükay
authors.forename: R Sarper
authors.initials: RS
authors.lastname: Okten
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yurdakul
authors.forename: Ensar
authors.initials: E
authors.lastname: Ozdemir
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: E Birol
authors.initials: EB
authors.lastname: Bostancı
authors.forename: Tülay
authors.initials: T
authors.lastname: Olçer
authors.forename: Turhan
authors.initials: T
authors.lastname: Cumhur
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002779:Cholestasis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011474:Prosthesis Design; D011788:Quality of Life; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D008670:Metals