title: Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: a multicenter prospective study.
abstract: BACKGROUND
  Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent.
  
  
  OBJECTIVE
  We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures.
  
  
  METHODS
  Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency.
  
  
  RESULTS
  Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during follow-up (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively.
  
  
  CONCLUSIONS
  The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.
authors.affiliation: Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jun Kyu
authors.initials: JK
authors.lastname: Lee
authors.forename: Tae Hyeon
authors.initials: TH
authors.lastname: Kim
authors.forename: Jong Hyeok
authors.initials: JH
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D062606:Tertiary Care Centers
chemical_list: D000497:Alloys; D008670:Metals; C013616:nitinol