title: Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction.
abstract: OBJECTIVE
  Endoscopic reintervention for stent occlusions following bilateral self-expandable metallic stent (SEMS) placement for malignant hilar biliary obstruction (MHBO) is challenging, and time to recurrent biliary obstruction (RBO) of the revisionary stent remains unclear. We aimed to clarify a suitable reintervention method for stent occlusions following bilateral SEMS placement for MHBO.
  
  
  METHODS
  Between 2002 and 2014, 52 consecutive patients with MHBO who underwent endoscopic reintervention for stent occlusion after bilateral SEMS placement were enrolled at two university hospitals and one tertiary care referral center. We retrospectively evaluated the technical and functional success rates of the reinterventions, and the time to RBO of the revisionary stents.
  
  
  RESULTS
  Technical and functional success rates of the reinterventions were 92% (48/52) and 90% (43/48), respectively. Univariate analysis did not determine any significant predictive factors for technical and functional failures. Median time to RBO of the revisionary stents was 68 days. Median time to RBO was significantly longer for revisionary SEMS placement than for plastic stent placement (131 days vs 47 days, respectively; log-rank test, P = 0.005). Revisionary SEMS placement was the only independent factor that was significantly associated with a longer time to RBO of the revisionary stent in the multivariate Cox proportional hazards analysis (hazard ratio 0.37; 95% confidence interval 0.14-0.95; P = 0.039).
  
  
  CONCLUSIONS
  Revisionary SEMS placement is a suitable endoscopic reintervention method for stent occlusion following bilateral SEMS placement from the perspective of time to RBO of the revisionary stent.
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.|Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.
authors.forename: Tadahisa
authors.initials: T
authors.lastname: Inoue
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.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ozeki
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Kaiki
authors.initials: K
authors.lastname: Anbe
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Hirotada
authors.initials: H
authors.lastname: Nishie
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizushima
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoneda
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D001650:Bile Duct Neoplasms; D002779:Cholestasis / Q000628:therapy*; D006801:Humans; D010166:Palliative Care; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D015607:Stents
keywords: malignant hilar biliary obstruction; recurrent biliary obstruction; reintervention; revisionary stent; self-expandable metallic stent