title: Third metal stent for revision of malignant hilar biliary strictures.
abstract: Background and study aim:Endoscopic stent-in-stent (SIS) placement of multiple metal stents is technically demanding. In the present study, we explored the technical feasibility and efficacy of endoscopic deployment of a third metal stent to create a triple SIS placement in patients with a bilateral SIS configuration for inoperable high grade malignant hilar biliary stricture (HBS) that had failed clinically.Methods:Eighteen patients with histologically proven inoperable HBS underwent deployment of an additional third metal stent as a revisionary method after early clinical failure following technically successful bilateral SIS placement using cross-wired metal stents. The main outcome measures were the technical and clinical success rates, and adverse events.Results:The overall technical and clinical success rates were 88.9 % (16/18) and 87.5 % (14/16), respectively. The early and late complications were cholangitis (n = 2) and cholecystitis (n = 1). Stent occlusion developed in 35.7 % (5/14) of patients in whom a third metal stent for revision of a bilateral SIS configuration was clinically successful. The median (range) times for stent patency and patient survival were 176 days (49 - 372) and 216 days (52 - 384), respectively.Conclusions:Endoscopic deployment of an additional third metal stent into a bilateral SIS configuration was technically feasible and effective in patients with inoperable high grade malignant HBS in whom bilateral SIS placement had failed clinically.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.
authors.forename: Moon Han
authors.initials: MH
authors.lastname: Choi
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D018281:Cholangiocarcinoma / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D000069322:Self Expandable Metallic Stents