title: Management of occluded metallic stents in malignant hilar biliary stricture.
abstract: OBJECTIVE
  Little is known about the management of occluded multiple metallic stent (MS) deployed in malignant hilar biliary strictures (HBS). The purpose of this study was to evaluate the endoscopic management of occluded multiple MSs deployed in HBS.
  
  
  METHODS
  Fifty-five patients with unresectable biliary tract carcinoma had multiple MSs inserted due to HBS. The endoscopic intervention through the duodenal papilla was performed on 30 cases that had MS occlusion. The procedure success rate, the survival time after the procedure and the number of endoscopic interventions before death were analyzed, retrospectively.
  
  
  RESULTS
  The causes of MS obstruction were tissue ingrowth (n=20), sludge (n=7), tumor overgrowth (n=2), and hemobilia (n=1). Endoscopic cleaning or deployment of plastic stents or metallic stents was performed on these patients and was successfully accomplished only via the transpapillary approach. The survival time after MS obstruction was 219 days. The median number of endoscopic interventions before death was 3. The median interval of endoscopic intervention after the first plastic stent occlusion was 84 days.
  
  
  CONCLUSIONS
  Our long-term data regarding the endoscopic management of occluded MSs deployed in malignant hilar biliary strictures are acceptable although the patency time of plastic stents deployed after MS occlusion was relatively short.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. sktng334@yahoo.co.jp
authors.forename: Masakuni
authors.initials: M
authors.lastname: Fujii
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Ken
authors.initials: K
authors.lastname: Hirao
authors.forename: Naoko
authors.initials: N
authors.lastname: Kurihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Mizuno
authors.forename: Etsuji
authors.initials: E
authors.lastname: Ishida
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Fukatsu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals