title: Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study.
abstract: BACKGROUND
  Bilateral self-expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6-Fr delivery systems could facilitate a single-step simultaneous side-by-side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure.
  
  
  METHODS
  Between May and September 2013, 13 consecutive patients with UMHBO underwent a single-step simultaneous side-by-side placement of SEMS with the 6-Fr delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database.
  
  
  RESULTS
  Technical success was achieved in 11 (84.6%, 95% confidence interval [CI]: 57.8-95.8) patients. The median procedure time was 25 min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI: 37-263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement.
  
  
  CONCLUSIONS
  A single-step simultaneous side-by-side placement of SEMS with a 6-Fr delivery system was feasible for the management of UMHBO.
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.forename: Taiki
authors.initials: T
authors.lastname: Kudo
authors.forename: Yoko
authors.initials: Y
authors.lastname: Abe
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kawahata
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Kubo
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kubota
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D016503:Drug Delivery Systems; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents
chemical_list: D020099:Coated Materials, Biocompatible
keywords: Malignant hilar biliary obstruction; Self-expandable metallic stent; Side-by-side placement