Bilateral biliary drainage for malignant hilar obstruction using the ‘stent-in-stent’ method with a Y-stent

Kim, Dong Uk; Kang, Dae Hwan; Kim, Gwang Ha; Song, Geun Am; Kim, Chang Won; Kim, Suk; Jang, Ae Lee

doi:10.1097/meg.0b013e3283590a2a

Cited by 22 publications

(21 citation statements)

References 26 publications

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“…Although the extent of liver drainage remains unclear in cases of malignant hilar obstruction, bilateral biliary drainage has become generally accepted in recent studies [5,8,10,11,15]. New devices and various techniques for bilateral metallic stent placement across the hilar malignancy have been reported, including T-configured, Y-configured, and crisscross-configured dual stent placement [3][4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors have described new devices and various techniques for bilateral bare metallic stent placement across the hilar malignancy, including T-configured [3][4][5][6], Y-configured [5][6][7][8], and crisscross-configured dual stent placement [5,9]. Moreover, successful use of covered stent was also reported in patients with malignant hilar biliary obstruction to provide durable stent patency without tumor ingrowth [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent

Yun

Jung

Park

et al. 2015

Cardiovasc Intervent Radiol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent

Yun

Jung

Park

et al. 2015

Cardiovasc Intervent Radiol

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“…Stent occlusion rates are usually between 25% and 39%. [43][44][45][46] Cholecystitis (28% late and 9% early) and cholangitis (16% late and 6% early) are reported complications of Y-stents. 47 Another stent without wide mesh in the middle was evaluated in 35 patients and demonstrated 94% placement success rate, mean patency of 150 days and very low rate of cholangitis (6%).…”

mentioning

confidence: 99%

Comprehensive management of cholangiocarcinoma: Part II. Treatment

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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Cholangioarcinoma is a rare but dreadful malignancy which poses much difficulties in the management. If detected early with only localized disease, curative resection is possible. However, most patients present in the late stages of the disease, which are managed with endoscopic biliary drainage and/or chemoradiation. Liver transplantation offers a possibility for cure in the distal and the perihilar tumors for selected candidates. Local treatments, such as hepatic artery-based therapies, brachytherapy, and photodynamic therapy, may offer some benefit in cases of the advanced disease. In this review, we will assess the role of preoperative biliary drainage, how best to drain biliary obstruction, and the intricate details of various treatments that are currently available. Management of Cholangiocarcinoma Preoperative biliary drainagePreoperative biliary drainage (PBD) is achieved with endoscopic or percutaneous approach. The topic is controversial and the review of the literature revealed conflicting results. PBD of the future remnant hepatic lobe is supposed to decrease hepatic dysfunction and liver failure postoperatively.1 The meta-analysis found no difference in mortality between patients with and without PBD and the authors advised that such procedure should not be performed routinely.2 Another meta-analysis of almost 5,000 patients with distal obstruction (425 with distal cholangiocarcinoma [DCC]) did not find any evidence that PBD (without distinguishing between endoscopic or percutaneous approach) increases morbidity or mortality. However it was associated with significant bacterial infection of the bile and possibly adverse outcomes after surgery.3 Other studies showed that PBD reduced jaundice, which positively affected outcomes, but not survival, and that it might be associated with more intraoperative blood loss, but less reoperation rates compared to non-drained cases. 4,5 The prospective randomized study of almost 200 patients with cancer of the head of the pancreas demonstrated that PBD was associated with more non-surgical adverse events compared to those managed only with surgery (46% vs 2%, respectively). Surgical adverse events were also more in the PBD group (47% vs 37%). The high incidence of cholangitis in those treated with PBD may be associated with the long lag time between PBD and surgery (5 weeks) and the high occlusion rate of plastic stents (PSs) (15%), prompting other authors to suggest that use of short, self-expandable metal stents (SEMS) may result in better outcomes for distal bile duct strictures. In accordance with other studies, there was no effect of PBD on mortality.6,7 In perihilar cholangiocarcinoma (PCC), the systematic review of 700 patients with and without PBD suggested that there is higher incidence of postoperative infections (18%-52% vs 0%-27%) and overall adverse events (36%-100% vs 29%-72%) in the PBD compared to the non-PBD group. There was no difference in mortality in the two groups. 8 Other studies favor the use of PBD in the preoperative management of PCC. ...

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“…70 They used an open weave stent, allowing for more flexibility in aligning this area at the hilum. 70 The weave is designed to tighten, thereby increasing radial force to maintain cannulation. Kim et al showed that these stents had a stent-in-stent placement of 87%, with cholangitis reported in 1.5% of patients.…”

mentioning

confidence: 99%

“…The Ystent bilateral technique is a viable option to treat malignant hilar obstruction. 10,70 In 2010, Chahal et al deployed bilateral SEMS with a stent-in-stent approach. 71 They used a large mesh SEMS with deployment across the bifurcation.…”

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confidence: 99%

An Update to Hepatobiliary Stents

Moy¹,

Bir²

2015

JCTH

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Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simple plastic stent technology has evolved significantly to include uncovered, partially covered, and fully covered self-expanding metal stents (SEMS) as well as magnetic, bioabsorbable, drug-eluting, and antireflux stents.

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Bilateral biliary drainage for malignant hilar obstruction using the ‘stent-in-stent’ method with a Y-stent

Abstract: With the development of new devices and increased technical experience, there were better outcomes during the late period compared with the early period. Endoscopic bilateral metal stenting using a Y-stent is an attractive option for the palliative treatment of malignant hilar obstruction.

Cited by 22 publications

References 26 publications

Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent

Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent

Comprehensive management of cholangiocarcinoma: Part II. Treatment

An Update to Hepatobiliary Stents

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