title: Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: prospective long-term study.
abstract: OBJECTIVE
  Although still controversial, bilateral stenting may be the best option for palliative drainage of malignant hilar biliary obstruction. The aim of our study was to evaluate the technical and clinical efficacies of endoscopic bilateral metal stenting using a biliary Y-stent for the management of malignant hilar obstruction.
  
  
  METHODS
  This prospective, uncontrolled study included 30 consecutive patients with unresectable malignant hilar strictures in whom we intended to perform endoscopic bilateral stent-in-stent deployment using a biliary Y-stent. After deployment of the Y-stent across the hilar stricture, a conventional biliary metal stent was inserted in a Y-configuration in which it traversed the wider-mesh central portion of the Y-stent to enter the opposite hepatic lobe.
  
  
  RESULTS
  Bilateral metal stenting using a Y-stent was successful in 26 of 30 patients (86.7%), and successful drainage was achieved in all 26 patients (100%). Early complications occurred in 3 patients (cholangitis, 1; cholecystitis, 2) without procedure-related mortality. As late complications during the follow-up period (median, 176 days; range, 70-473 days), stent occlusion occurred in 10 of 26 patients (38.5%). Four patients were managed with the insertion of a plastic stent through the occluded metal stent, and the remaining patients were treated with percutaneous biliary drainage. The median survival and stent patency were 176 days and 140 days, respectively.
  
  
  CONCLUSIONS
  Y-shaped endoscopic bilateral stenting using a Y-stent appears to be a feasible and effective method with high technical success and low stent-related complications for palliation of unresectable malignant hilar biliary obstruction.
authors.affiliation: Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, Suwon, Republic of Korea.
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Sun Gyo
authors.initials: SG
authors.lastname: Lim
authors.forename: Soon Sun
authors.initials: SS
authors.lastname: Kim
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016145:Endoscopy, Digestive System; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome