title: Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction.
abstract: BACKGROUND
  Although endoscopic biliary stents have been accepted as part of palliative therapy for cases of malignant hilar obstruction, the optimal endoscopic management regime remains controversial. In this study, we evaluated the safety and efficacy of placing a threaded stent above the sphincter of Oddi (threaded inside plastic stents, threaded PS) and compared the results with those of other stent types.
  
  
  METHODS
  Patients with malignant hilar obstruction, including those requiring biliary drainage for stent occlusion, were selected. Patients received either one of the following endoscopic indwelling stents: threaded PS, conventional plastic stents (conventional PS), or metallic stents (MS). Duration of stent patency and the incident of complication were compared in these patients.
  
  
  RESULTS
  Forty-two patients underwent placement of endoscopic indwelling stents (threaded PS = 12, conventional PS = 17, MS = 13). The median duration of threaded PS patency was significantly longer than that of conventional PS patency (142 vs. 32 days; P = 0.04, logrank test). The median duration of threaded PS and MS patency was not significantly different (142 vs. 150 days, P = 0.83). Stent migration did not occur in any group. Among patients who underwent threaded PS placement as a salvage therapy after MS obstruction due to tumor ingrowth, the median duration of MS patency was significantly shorter than that of threaded PS patency (123 vs. 240 days).
  
  
  CONCLUSIONS
  Threaded PS are safe and effective in cases of malignant hilar obstruction; moreover, it is a suitable therapeutic option not only for initial drainage but also for salvage therapy.
authors: Division of Gastroenterology, Shiga University of Medical Science, Seta-Tsukinowa cho, Otsu, Shiga, Japan. osam@belle.shiga-med.ac.jp
authors: Osamu
authors: O
authors: Inatomi
authors: Shigeki
authors: S
authors: Bamba
authors: Makoto
authors: M
authors: Shioya
authors: Yosuke
authors: Y
authors: Mochizuki
authors: Hiromitsu
authors: H
authors: Ban
authors: Tomoyuki
authors: T
authors: Tsujikawa
authors: Yasuharu
authors: Y
authors: Saito
authors: Akira
authors: A
authors: Andoh
authors: Yoshihide
authors: Y
authors: Fujiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery*; D002779:Cholestasis / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010969:Plastics; D012189:Retrospective Studies; D015607:Stents / Q000145:classification*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics