Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent.
OBJECTIVE
To evaluate the technical feasibility and clinical efficacy of placement of a newly designed Y-shaped branched covered stent for palliative treatment of malignant hilar biliary obstruction.


METHODS
From June 2011 to September 2014, 34 consecutive patients with malignant hilar biliary obstruction underwent percutaneous placement of a Y-shaped branched covered stent for palliative treatment. Technical and clinical success, complications, cumulative patient survival, and stent patency were evaluated.


RESULTS
Stent placement was technically successful in all patients. All patients showed adequate biliary drainage on the follow-up cholangiogram. Mean serum bilirubin level (10.9 mg/dl) decreased significantly 1 week (5.7 mg/dl) and 1 month (2.6 mg/dl) after stent placement (p < 0.01). Complications associated with the procedure included hemobilia (n = 3) and biloma (n = 1). During the mean follow-up period of 225 (range 12-820) days, nine patients (26.5%) developed stent occlusion caused by tumor overgrowth (n = 8) and sludge (n = 1). Two of them underwent coaxial placement of a second stent with good results. The median survival time was 281 days and median primary stent patency was 337 days. There were no significant differences in the patient survival and stent patency rates in relation to age, sex, or Bismuth type.


CONCLUSIONS
Percutaneous placement of the Y-shaped branched covered stent seems to be technically feasible and clinically effective for palliative treatment of malignant hilar biliary obstruction.
Departments of Diagnostic Radiology, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea. xell1015@naver.com.
Jong Hyouk
JH
Yun
Departments of Diagnostic Radiology, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea. gsjung@medimail.co.kr.
Gyoo-Sik
GS
Jung
Departments of Diagnostic Radiology, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea.
Jung Gu
JG
Park
Departments of Radiology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, 158-710, Korea.
Byung Chul
BC
Kang
Departments of General Surgery, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea.
Dong-Hoon
DH
Shin
Departments of Internal Medicine, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea.
Byung Chul
BC
Yun
Departments of Internal Medicine, Kosin University College of Medicine, 34, Amnam-Dong, Seo-gu, Busan, 602-702, Korea.
Sang Uk
SU
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019919:Prosthesis Implantation / Q000295:instrumentation; D015607:Stents; D016896:Treatment Outcome
Bile duct neoplasms; Biliary obstruction; Malignancy; Stents and prostheses