title: Efficacy of plastic stent placement inside bile ducts for the treatment of unresectable malignant hilar obstruction (with videos).
abstract: BACKGROUND
  Recent reports have addressed the utility of plastic stent (PS) placement inside bile ducts for treating biliary obstructions. Here, we evaluated the utility and safety of PS placement inside bile ducts for treating unresectable malignant hilar biliary obstruction.
  
  
  METHODS
  We conducted a retrospective study of 27 patients with unresectable malignant hilar biliary obstruction who underwent intraductal modified PS placement. We modified the PS, by cutting off the distal end to facilitate insertion through the papilla of Vater, and attached a nylon thread to the distal end for removal. We evaluated complications, the time to recurrent biliary obstruction (TRBO), and removability.
  
  
  RESULTS
  Bilateral stenting was performed in nine of the 27 patients. Mild acute pancreatitis occurred in one patient (4%). Recurrent biliary obstruction (RBO) occurred in 16 patients (59%), with a median TRBO of 190 days (95% confidence interval: 174-205 days). Reintervention was necessary in 13 of the 16 patients (81%) with RBO, and we were able to remove the initial stents in all the patients who required reintervention.
  
  
  CONCLUSIONS
  A relatively long stent patency period (>6 months) and removability make placement of a modified PS inside bile ducts a viable treatment for unresectable malignant hilar biliary obstruction.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 2320024, Japan. taku47@yokohama-cu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Yuro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Haruo
authors.initials: H
authors.lastname: Miwa
authors.forename: Eri
authors.initials: E
authors.lastname: Kameta
authors.forename: Ryonho
authors.initials: R
authors.lastname: Koh
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy*; D002779:Cholestasis / Q000175:diagnosis / Q000628:therapy*; D003952:Diagnostic Imaging; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010969:Plastics; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010969:Plastics
keywords: Intraductal placement; Malignant hilar biliary obstruction; Plastic stent