A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

Brountzos, Elias; Ptochis, Nikolaos; Panagiotou, Irene; Malagari, Katerina; Tzavara, Chara; Kelekis, Dimitrios

doi:10.1007/s00270-005-0379-3

Cited by 82 publications

(95 citation statements)

References 24 publications

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“…This retrospective study was designed to investigate the clinical efficiency, as judged by survival and relief from jaundice symptoms, following percutaneous bi-lobar stenting for the management of Bismuth Ⅳ malignant disease. Bismuth Ⅳ disease has been identified as an independent predictor of almost 5-fold increased mortality following PTBS [17] . In this series the mean survival time of 169 d is comparable and even superior to previously reported results involving patients with less advanced, Bismuth Ⅰ -Ⅳ, disease [2,3] .…”

Section: Discussionmentioning

confidence: 99%

“…In very advanced disease the clinical effectiveness of single-lobe drainage remains controversial as some authors have reported superior patency rates and clinical outcomes in patients with Bismuth type Ⅳ obstruction when both biliary ducts were stented [12] . Furthermore, in cases of extensive right lobe tumour, unilateral right bile drainage could result in insufficient serum bilirubin level decrease, a clinical endpoint that has been identified as a main independent predictor of survival [17] . On the other hand, single left lobe drainage is rarely sufficient to eliminate or ease obstructive symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Karnabatidis

Spiliοpoulos²,

Katsakiori³

et al. 2013

WJH

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AIM:To investigate the clinical efficiency of percutaneous trans-hepatic bilateral biliary metallic stenting for the management of Bismuth Ⅳ malignant obstructive disease. METHODS:Our hospital's database was searched for all patients suffering from the inoperable malignant biliary obstruction Bismuth Ⅳ, and treated with percutaneous bilateral trans-hepatic placement of selfexpandable nitinol stents. The indication for percutaneous stenting was an inoperable, malignant, symptomatic, biliary obstruction. An un-correctable coagulation disorder was the only absolute contra-indication for treatment. Bismuth grading was performed using magnetic resonance cholangiopancreatography. Computed tomography evaluation of the lesion and the dilatation status of the biliary tree was always performed prior to the procedure. All procedures were performed under conscious sedation. A single trans-hepatic track technique was preferred (T-configuration stenting) and a second, contra-lateral trans-hepatic track (Y-configuration stenting) was used only in cases of inability to access the contra-lateral lobe using a single track technique. The study's primary endpoints were clinical success, defined as a decrease in bilirubin levels within 10 d and patient survival rates. Secondary endpoints included peri-procedural complications, primary and secondary patency rates. RESULTS:A total of 35 patients (18 female, 51.4%) with a mean age 69 ± 13 years (range 33-88) were included in the study. The procedures were performed between March 2000 and June 2008 and mean time follow-up was 13.5 ± 22.0 mo (range 0-96). The underlying malignant disease was cholangiocarcinoma (n = 10), hepatocellular carcinoma (n = 9), pancreatic carcinoma (n = 5), gastric cancer (n = 2), bile duct tumor (n = 2), colorectal cancer (n = 2), gallbladder carcinoma (n = 2), lung cancer (n = 1), breast cancer (n = 1) or non-Hodgkin lymphoma (n = 1). In all cases, various self-expandable bare metal stents with diameters ranging from 7 to 10 mm were used. Stents were placed in Y-configuration in 24/35 cases (68.6%) using two stents in 12/24 patients and three stents in 12/24 cases (50%). A T-configuration stent placement was performed in 11/35 patients (31.4%), using two stents in 4/11 cases (36.4%) and three stents in 7/11 cases (63.6%). Follow-up was available in all patients (35/35). Patient survival ranged from 0 to 1763 d and the mean survival time was 168 d. Clinical success rate was 77.1% (27/35 cases), and peri-procedural mortality rate was 5.7% (2/35 patients). Biliary reobstruction due to stent occlusion occurred in 25.7% of the cases (9/35 patients), while in 7/11 (63.6%) one additional percutaneous re-intervention due to stent occlusion resulting in clinical relapse of symptomatology was successfully performed. In the remaining Karnabatidis D et al . Percutaneous bilateral biliary stenting 4/11 patients (36.4%) more than 1 additional reintervention was performed. The median decrease of total serum bilirubin was 60.5% and occurred in 81.8% of the cases (27/...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Karnabatidis

Spiliοpoulos²,

Katsakiori³

et al. 2013

WJH

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“…Malignant obstructive jaundice can lead to hyperbilirubinemia, anorexia, pruritus, cholangitis, septicemia and liver failure. Generally, surgical resection remains the primary treatment for malignant obstructive jaundice; however, in numerous cases the malignant obstructive jaundice is detected when the disease is already at an advanced stage (2). For the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function, in order to facilitate the addition of subsequent anti-tumor therapy to their treatment regimen.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases

Shao

Fang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Malignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary and extra-biliary carcinomas. Generally, surgical resection is the primary treatment for malignant obstructive jaundice; however, for the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function. Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice. PTBD and stenting have exhibited good efficacy for the treatment of malignant obstructive jaundice, with few complications and reduced associated pain. IntroductionMalignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary carcinomas, such as cholangiocarcinoma and gallbladder cancer, and extra-biliary carcinomas, such as ampullary, pancreatic and gastric cancer and hepatocellular carcinoma (1). Malignant obstructive jaundice can lead to hyperbilirubinemia, anorexia, pruritus, cholangitis, septicemia and liver failure. Generally, surgical resection remains the primary treatment for malignant obstructive jaundice; however, in numerous cases the malignant obstructive jaundice is detected when the disease is already at an advanced stage (2). For the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function, in order to facilitate the addition of subsequent anti-tumor therapy to their treatment regimen. The average survival time of patients with obstructive jaundice is <3 months (3). Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice that exhibit good clinical efficacy and few complications and lead to limited patient suffering. PTBD and stenting is the first choice for elderly patients, patients with inoperable malignant obstructive jaundice, and patients with postoperative recurrence, diabetes, or cardiovascular disease. Case reportCase 1. The patient was a 51-year-old man who presented with ~3 weeks' history of obstructive jaundice. The patient was admitted to Fuyan People's Hospital (Fuyang, China) on June 12, 2014. Liver and kidney function analyses, and routine blood tests were conducted upon admission; and heaptic bilirubin levels were higher than normal. Abdominal computed tomography (CT) showed pancreatic cancer, as well as dilation of the intra-and extrahepatic bile ducts. The patient was at an advanced disease stage and refused to undergo surgical resection. PTBD and stenting were performed in the interventional operating room following the provision of informed consent by the patient. The procedure to puncture the biliary duct was guided under ultrasound (US). An 18-G Chiba needle and a 0.035-inch guide-wire were used to gain access to the biliary system using a right-sided puncture approach. An 8-F sheath was inserted to facilitate the procedure. A 0.035-inch hydrophilic guide-wire was advanced through the stenosis into the duodenum. The hydrophilic guide-wire was...

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“…In the sixth month, the cumulative patency rate was 50%. Overall, mean primary patency rates in different series were between 141 and 231 days (8)(9)(10)(11)(12)(13)(14)(15). In the study by Maybody et al (10), an overall mean primary patency rate of 227.7 days was found in patients with multiple noncoaxial stents.…”

Section: Discussionmentioning

confidence: 94%

Triple metallic stenting in hilar malignant biliary obstructions

Küçükay

Ökten²,

Yurdakul³

et al. 2010

Diagn Interv Radiol

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A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

Cited by 82 publications

References 24 publications

Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases

Triple metallic stenting in hilar malignant biliary obstructions

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