title: Endoscopic bilateral metallic stenting for malignant hilar obstruction using newly designed stents.
abstract: OBJECTIVE
  Whether unilateral or bilateral drainage should be performed for malignant hilar biliary obstruction is controversial. Moreover, endoscopic placement of bilateral metallic stents is difficult and complicated.
  
  
  METHODS
  New metallic stents, such as the Niti-S Y-type stent (Y-stent), BONASTENT M-Hilar, and Niti-S large cell D-type stent (LCD), have recently been developed for bilateral stent-in-stent procedures to facilitate contralateral stent deployment through the interstices of the first metallic stent. We review the features and efficacy of these metallic stents designed for bilateral drainage in patients with hilar biliary obstruction.
  
  
  RESULTS
  The newly designed stents examined exhibited high technical success rates, low stent-related complications, and good stent patency. Endoscopic reinterventions for occluded stents could be performed easily, particularly in patients with bilateral LCD placement.
  
  
  CONCLUSIONS
  Endoscopic bilateral stenting using newly designed metallic stents is feasible, safe, and effective in patients with unresectable malignant hilar biliary obstruction.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. kogureh-tky@umin.ac.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010166:Palliative Care / Q000379:methods; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome