title: Efficacy of Endoscopic Over 3-branched Partial Stent-in-Stent Drainage Using Self-expandable Metallic Stents in Patients With Unresectable Hilar Biliary Carcinoma.
abstract: BACKGROUND
  The treatment of biliary stricture is crucially important for continuing stable chemotherapy for unresectable biliary carcinoma; however, there is no consensus regarding the use of hilar biliary drainage. In this study, we examined the efficacy of endoscopic over 3-branched biliary drainage using self-expandable metallic stents (SEMSs) in patients with unresectable malignant hilar biliary stricture (HBS).
  
  
  METHODS
  A total of 77 patients with unresectable HBS treated with a SEMS and chemotherapy were retrospectively reviewed. There were 59 patients with cholangiocarcinoma and 18 patients with gallbladder carcinoma. The patients were divided into 2 groups (4- or 3-branched group and 2- or 1-branched group) and compared with respect to the duration of stent patency and overall survival.
  
  
  RESULTS
  A comparison of the patients' baseline characteristics showed no significant differences between the 4- or 3-branched group and the 2- or 1-branched group. Neither the duration of patency nor survival time exhibited significant differences between the 2 groups, although, among the patients achieving disease control , the duration of patency period and survival time of the 4- or 3-branched group were significantly higher than those observed in the 2- or 1-branched group (P=0.0231 and 0.0466).
  
  
  CONCLUSIONS
  The use of endoscopic over 3-branched biliary drainage with a SEMS may improve the duration of patency in patients with HBS.
authors.affiliation: *Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences †Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School ‡Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Uchida
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Muro
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Noma
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Horiguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome