Metallic stent deployment in endosonography-guided biliary drainage: long-term follow-up results in patients with bilio-enteric anastomosis.
OBJECTIVE
Although reports on endosonography-guided biliary drainage (ESBD) have been increasing, only a few reports on deployment of a self-expandable metal stents (SEMS) have been reported. The aim of the present study was to evaluate the safety and efficacy of SEMS deployment in ESBD.


METHODS
Of 42 patients who underwent ESBD during the period from January 2007 to August 2011, 21 patients with unresectable malignant biliary obstruction in whom SEMS deployment had been attempted were included. In the first session, a plastic stent or SEMS was placed in a bilio-enteric anastomosis (BEA) method. SEMS was deployed with the one-step technique or with replacement of a plastic stent with a SEMS in the second session. The technical success, early and late complications, and stent patency of SEMS were evaluated.


RESULTS
One-step SEMS deployment was attempted in seven patients, and SEMS was deployed with stent exchange in 14. SEMS deployment was successful in all patients without any complications. Finally, SEMS was placed in a BEA method in 16 patients (extrahepatic bile duct, 13; intrahepatic bile duct, three), and with antegrade deployment in five. Late complications occurred in three patients who underwent deployment of SEMS in a BEA method (stent obstruction in two and reflux cholangitis in one). The mean stent patency period was 433 days.


CONCLUSIONS
As SEMS deployment in ESBD is safe and provides long stent patency, a SEMS seems to be the stent of choice in ESBD for patients with unresectable malignant biliary obstruction in whom long survival is expected.
Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. j-hora@qg7.so-net.ne.jp
Jun
J
Horaguchi
Naotaka
N
Fujita
Yutaka
Y
Noda
Go
G
Kobayashi
Kei
K
Ito
Shinsuke
S
Koshita
Yoshihide
Y
Kanno
Takahisa
T
Ogawa
Kaori
K
Masu
Shinichi
S
Hashimoto
Shoutarou
S
Ishii
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery / Q000648:ultrastructure; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome