title: Endoscopic inside stent placement is suitable as a bridging treatment for preoperative biliary tract cancer.
abstract: BACKGROUND
  Endoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer. However, reflux cholangitis arising from bacterial adherence to the inner wall of the stent must be avoided. We evaluated the use of EBS above the sphincter of Oddi to determine whether reflux cholangitis could be prevented in preoperative cases.
  
  
  METHODS
  Fifty-seven patients with primary biliary tract cancer were retrospectively recruited for the evaluation of stent placement either above (n = 25; inside stent group) or across (n = 32; conventional stent group) the sphincter of Oddi. We compared the stent patency periods prior to the time of surgical resection.
  
  
  RESULTS
  The preoperative periods were 96.3 days in the conventional stent group and 96.8 days in the inside stent group (P = 0.979). Obstructive jaundice and/or acute cholangitis occurred in 7 patients (28.0%) in the inside stent group and in 15 patients (46.9%) in the conventional stent group during the preoperative period (P = 0.150). The average patency periods of the stents were 85.2 days (range, 13-387 days) for the inside stent group and 49.1 days (range, 9-136 days) for the conventional stent group (log-rank test: P = 0.009). The mean numbers of re-interventions because of stent occlusion were 0.32 for the inside stent group and 1.03 for the conventional stent group (P = 0.026). Post-endoscopic retrograde cholangiopancreatography complications occurred in 2 patients in the inside stent group and 4 patients in the conventional stent group (P = 0.516). Postoperative liver abscess occurred in 1 patient in the inside stent group and 5 patients in the conventional stent group (P = 0.968). Inside stent placement was the only significant preventative factor associated with stent obstruction based on univariate (hazard ratio [HR], 0.286; 95% confidence interval [CI], 0.114-0.719; P = 0.008) and multivariate (HR, 0.292; 95% CI, 0.114-0.750; P = 0.011) analyses.
  
  
  CONCLUSIONS
  Temporary plastic stent placement above the sphincter of Oddi is a better bridging treatment than conventional stent placement in preoperative primary biliary tract cancer.
authors: Medical Oncology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. norikoba@yokohama-cu.ac.jp.|Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. norikoba@yokohama-cu.ac.jp.
authors: Noritoshi
authors: N
authors: Kobayashi
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. marine04270810@yahoo.co.jp.
authors: Seitaro
authors: S
authors: Watanabe
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. hiro1017@fukuhp.yokohama-cu.ac.jp.
authors: Kunihiro
authors: K
authors: Hosono
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. kubotak@yokohama-cu.ac.jp.
authors: Kensuke
authors: K
authors: Kubota
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. nakajima-tky@umin.ac.jp.
authors: Atsushi
authors: A
authors: Nakajima
authors: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan. taku47@urahp.yokohama-cu.ac.jp.
authors: Takashi
authors: T
authors: Kaneko
authors: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan. sugimori@urahp.yokohama-cu.ac.jp.
authors: Kazuya
authors: K
authors: Sugimori
authors: Medical Oncology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. tokuhisa@yokohama-cu.ac.jp.|Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. tokuhisa@yokohama-cu.ac.jp.
authors: Motohiko
authors: M
authors: Tokuhisa
authors: Medical Oncology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. qq9v6m3u9@able.ocn.ne.jp.|Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. qq9v6m3u9@able.ocn.ne.jp.
authors: Ayumu
authors: A
authors: Goto
authors: Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. rmori@ck2.so-net.ne.jp.
authors: Ryutaro
authors: R
authors: Mori
authors: Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. t1006koichi@yahoo.co.jp.
authors: Koichi
authors: K
authors: Taniguchi
authors: Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. ryusei@terra.dti.ne.jp.
authors: Ryusei
authors: R
authors: Matsuyama
authors: Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. endoit@med.yokohama-cu.ac.jp.
authors: Itaru
authors: I
authors: Endo
authors: Gastroenterology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. smaeda@yokohama-cu.ac.jp.
authors: Shin
authors: S
authors: Maeda
authors: Medical Oncology Division, Yokohama City University School of Medicine, 3-9, Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. yasu0514@med.yokohama-cu.ac.jp.
authors: Yasushi
authors: Y
authors: Ichikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D018285:Klatskin Tumor / Q000601:surgery*; D008100:Liver Abscess / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D010969:Plastics; D011300:Preoperative Care; D011475:Prosthesis Failure / Q000009:adverse effects*; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D009803:Sphincter of Oddi; D015607:Stents / Q000009:adverse effects* / Q000382:microbiology; D013997:Time Factors
chemical_list: D010969:Plastics
references: J Hepatobiliary Pancreat Sci. 2011 Sep;18(5):630-5
references: 21655974
references: J Gastroenterol. 2011 Feb;46(2):242-8
references: 20700608
references: J Gastroenterol. 2012 Nov;47(11):1165-76
references: 22847554
references: Ann Oncol. 2014 Feb;25(2):391-8
references: 24351397
references: Ann Surg. 1999 Nov;230(5):663-71
references: 10561090
references: Ann Surg. 2003 Jul;238(1):73-83
references: 12832968
references: Transplantation. 2003 Sep 15;76(5):810-5
references: 14501859
references: Br J Surg. 1988 Dec;75(12):1166-8
references: 2466520
references: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references: 2070995
references: Ann Surg. 1992 Jan;215(1):31-8
references: 1309988
references: World J Surg. 1992 May-Jun;16(3):536-40
references: 1589993
references: Lancet. 1992 Dec 19-26;340(8834-8835):1488-92
references: 1281903
references: Gastrointest Endosc. 1998 Dec;48(6):574-9
references: 9852446
references: Lancet. 1994 Dec 17;344(8938):1655-60
references: 7996958
references: Br J Surg. 1994 Aug;81(8):1195-8
references: 7741850
references: Endoscopy. 1998 Oct;30(8):687-90
references: 9865557
references: J Gastroenterol. 2005 Mar;40(3):291-6
references: 15830289
references: J Hepatobiliary Pancreat Surg. 2006;13(6):502-10
references: 17139423
references: Langenbecks Arch Surg. 2009 Nov;394(6):1065-72
references: 19169703
references: Gan To Kagaku Ryoho. 2009 Nov;36(12):2009-11
references: 20037307
references: Gastrointest Endosc. 2012 May;75(5):1080-5
references: 22401821