title: 8-mm versus 10-mm diameter self-expandable metallic stent in bilateral endoscopic stent-in-stent deployment for malignant hilar biliary obstruction.
abstract: BACKGROUND
  We aimed to clarify the clinical benefits of using 8-mm versus 10-mm diameter self-expandable metallic stent (SEMS) in bilateral endoscopic stent-in-stent (SIS) deployment for malignant hilar biliary obstruction (MHBO).
  
  
  METHODS
  A total of 72 consecutive patients with MHBO treated by endoscopic bilateral SIS deployment were enrolled. The 8-mm and 10-mm diameter SEMSs were used in 37 patients (8-mm group) and 35 patients (10-mm group), respectively. We retrospectively compared technical success, functional success, complications, successful re-intervention, time to recurrent biliary obstruction (RBO) and survival time between two groups.
  
  
  RESULTS
  There were no significant inter-group differences in terms of technical success (8-mm vs. 10-mm group, both 100%), functional success (96% vs. 100%), early (5% vs. 9%) and late (19% vs. 14%) complications other than RBO, and successful endoscopic re-intervention (94% vs. 100%), respectively. Time to RBO (median: 198 days vs. 222 days; log-rank, P = 0.440) and survival time (median: 186 days vs. 235 days; log-rank, P = 0.883) did not differ significantly between the two groups. However, the success rate of endoscopic bilateral revisionary stent insertion for RBO was significantly higher in the 10-mm compared to the 8-mm group (68% vs. 31%; P = 0.044).
  
  
  CONCLUSIONS
  The 10-mm diameter SEMS is more suitable with regard to endoscopic re-intervention.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. inaito@med.nagoya-cu.ac.jp.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Tesshin
authors.initials: T
authors.lastname: Ban
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Hirano
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takada
authors.forename: Shozo
authors.initials: S
authors.lastname: Togawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D002779:Cholestasis / Q000209:etiology* / Q000628:therapy*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: Bilateral stent; Hilar malignant biliary obstruction; Re-intervention; Self-expandable metallic stent; Stent-in-stent