title: Percutaneous bilateral metallic stent placement using a stentin-stent deployment technique in patients with malignant hilar biliary obstruction.
abstract: OBJECTIVE
  The purpose of this study is to investigate the technical and clinical efficacy of percutaneous bilateral stent-in-stent deployment using open cell-design stents and to compare the clinical outcomes of bilateral stent placement using T and Y configurations.
  
  
  METHODS
  From January 2006 to December 2010, 106 patients with malignant hilar biliary obstruction (Bismuth type II or higher) were included in this retrospective study. All patients were treated with percutaneous bilateral stent-in-stent deployment using open cell-design stents (64 in a T configuration and 42 in a Y configuration).
  
  
  RESULTS
  Bilateral stent-in-stent deployment was technically successful in all patients. Seven patients (6.6%) had major complications, including one with severe hemobilia, two with acute cholecystitis, and four with cholangitis; seven (6.6%) patients had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in 94 patients (88.7%). Stent occlusion by tumor ingrowth, with or without overgrowth, occurred in 37 patients (34.9%). The median survival and stent patency times were 192 days (95% CI, 153.6-230.4 days) and 319 days (95% CI, 148.5-489.5 days), respectively. Stent configuration did not significantly affect technical success, complications, successful internal drainage, patient survival, or stent patency.
  
  
  CONCLUSIONS
  Percutaneous bilateral stent-in-stent placement using open cell-design stents is effective for bilateral drainage in patients with malignant hilar biliary obstruction. In addition, there was no significant difference in technical and clinical outcomes between T and Y stent configurations.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. radgwon@amc.seoul.kr
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Kyung-Ah
authors.initials: KA
authors.lastname: Kim
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D008670:Metals