title: Feasibility of one-step endoscopic metal stenting for distal malignant biliary obstruction.
abstract: BACKGROUND
  We aimed to clarify the clinical usefulness of one-step self-expandable metal stent (SEMS) placement for distal malignant biliary obstruction by comparing with two-step SEMS placement.
  
  
  METHODS
  We retrospectively compared early complications, bilirubin level decreasing rate, and period of hospitalization between 40 patients with one-step SEMS and 52 patients with two-step SEMS. We also evaluated the complications in patients with two-step SEMS by classifying them into first drainage (ERBD or ENBD) and second drainage (SEMS).
  
  
  RESULTS
  The total incidence of early complications was significantly higher in patients with one-step SEMS than the second drainage of two-step SEMS (42.5% [17/40] vs. 13.5% [7/52]; P = 0.004). However, there was no significant difference in the early complications between one-step SEMS and two-step SEMS (total of first and second drainage) (42.5% [17/40] vs. 36.5% [19/52]; P = 0.561). The period required to reach the bilirubin level (<3 mg/dL) after initial drainage was significantly shorter in one-step SEMS than in two-step SEMS (5.7 vs. 10.1 days; P = 0.025). Similar results were observed in the period of hospitalization for patients without chemotherapy (22.2 vs. 37.3 days; P = 0.004).
  
  
  CONCLUSIONS
  One-step SEMS placement is the alternative option of drainage method for distal malignant biliary obstruction.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000150:complications*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D018281:Cholangiocarcinoma / Q000150:complications; D002779:Cholestasis / Q000628:therapy*; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents
keywords: Distal malignant biliary obstruction; One-step; Self-expandable metal stent; Two-step