Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique

Dumas, R; Demuth, Nicolas; Buckley, Martin; Peten, Emmanuel P.; Manos, Thierry; Demarquay, J. F.; Hastier, P; Caroli-Bosc, François-Xavier; Rampal, Patrick; Delmont, J

doi:10.1016/s0016-5107(00)70364-6

Cited by 101 publications

(95 citation statements)

References 18 publications

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“…An opinion supported by the findings in the RCT by Wagner et al [18]. According to Chang et al [60] and others, no or inadequate antibiotic prophylaxis [61] compared to routine prophylaxis [32, 55, 56], and undue contrast filling of liver segments without subsequent decompression [28, 61] compared to no or marginal filling [32, 55], will significantly increase post-procedure mortality and reduce survival. A contributing factor for decreased survival among unilaterally drained patients [60, 61] might have been the use of 7-french plastic stents instead of the 10-french stents used by DePalma et al [4], who found that septic complications after initial drainage did not affect survival.…”

Section: Discussionmentioning

confidence: 95%

“…In an RCT De Palma et al [4] found it to be technically easier to perform unilateral compared to bilateral drainage with plastic stents in terms of successful stent deployment. A finding that would be applicable for metal stent drainage as well, because greater experience and modified techniques translated into significantly more successful bilateral drainage attempts in a study by Dumas et al [56]. Except for one series [68], the use of plastic stents in PTBD compared to ERBD was found to be associated with significantly more complications (hemorrhage, death; table 5).…”

Section: Discussionmentioning

confidence: 98%

“…A contributing factor for decreased survival among unilaterally drained patients [60, 61] might have been the use of 7-french plastic stents instead of the 10-french stents used by DePalma et al [4], who found that septic complications after initial drainage did not affect survival. Furthermore, post-procedure antibiotic therapy which continued for 5 days (36 and 48 h, respectively, in the studies by Polydouru et al [32], and Dumas et al [56]), avoiding subsequent complete bilateral cholangiography, and prompt re-intervention (percutaneous or endoscopic complementary drainage of remaining obstructed ducts) when indicated, was found to be important [4]. Such measures will hopefully prevent septic complications from translating into increased mortality and reduced survival [32, 55].…”

Section: Discussionmentioning

confidence: 99%

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Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Hammarström

2005

Dig Surg

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Background: Endoscopic biliary drainage for malignant obstructive jaundice is a viable palliative alternative, but its role and cost-effectiveness compared to percutaneous drainage or surgical bypass are subject to debate. Aim: To review the evidence in the literature with regard to the settings in which endoscopic drainage favorably compares with and affords palliation and quality of life comparable to percutaneous drainage or surgical bypass in malignant obstructive jaundice patients. Method: Using PubMed, Embase, Current Contents, and Medline, a literature search was performed for papers published from 1979 to April 2004. All retrieved papers comparing endoscopic drainage with percutaneous or surgical drainage, with special reference to the level of obstruction, were rated according to the strength of evidence and carefully analyzed. Results and Conclusions: Palliative drainage affords improved quality of life. The outcome of endoscopic and percutaneous drainage was similar, but data were few and inconsistent. Due to fewer late complications, surgical bypass is an alternative to metal stents (Wallstent™) which remain patent longer than plastic stents (large-bore polyethylene), with an overall median of 180 and 109 days, respectively, in patients who survive longer than about 6 months, which cannot be accurately predicted though. Overall early and late morbidity, stent patency, and survival were similar in patients treated for hilar compared to distal obstruction.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Hammarström

2005

Dig Surg

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“…In the SIS technique, the second SEMS is inserted to the contralateral hepatic duct through the mesh of the first SEMS [16][17][18][19][20][21][22]. Conversely, in the SBS technique, two SEMSs are inserted parallel to each other into the right and left hepatic duct [23][24][25][26] (Fig. 1).…”

Section: Multiple Stenting Methods (Stent-in-stent or Side-by-side)mentioning

confidence: 99%

Endoscopic biliary stenting for unresectable malignant hilar obstruction

Fukasawa

Takano

Shindo

et al. 2017

Clin J Gastroenterol

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“…Drainage of both ductal sys− tems is desirable because there is a risk of cholangitis after endoscopic biliary in− tervention if drainage is incomplete [1,2]. The rates for mean survival, 30−day mor− tality, and death from sepsis in patients with Klatskin tumors are reported to be significantly better with bilateral self−ex− panding metal stents (SEMS) compared with unilateral stents [3].…”

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confidence: 99%

A new biliary ”Y” stent for hilar tumors

Ramchandani¹,

Lakhtakia²,

Gupta³

et al. 2007

Endoscopy

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Palliative treatment of malignant hilar biliary strictures is difficult, especially when the stricture involves both the right and left hepatic ducts (Bismuth types II and higher). Drainage of both ductal sys− tems is desirable because there is a risk of cholangitis after endoscopic biliary in− tervention if drainage is incomplete [1,2]. The rates for mean survival, 30−day mor− tality, and death from sepsis in patients with Klatskin tumors are reported to be significantly better with bilateral self−ex− panding metal stents (SEMS) compared with unilateral stents [3]. Endoscopic placement of two parallel SEMS is techni− cally demanding. To circumvent this problem, a "Y" stent has been designed which consists of two uncovered SEMS (Niti−S Biliary stent, Y type [Endoscopic approach]; TaeWoong Medical Co. Ltd., Kyonggi−Do, South Korea): the first SEMS has a radiologically marked segment with wider mesh holes in its middle part, through which the second stent is deliv− ered on the other side (Figure 1). We re− port a case of hilar cholangiocarcinoma (Bismuth type III), which was successfully palliatively treated using this biliary Y stent.A 66−year−old woman presented with jaundice of 3 weeks duration, and with weight loss and pruritus. Abdominal com− puted tomography confirmed the exis− tence of a hilar mass, which was surgical− ly unresectable. Endoscopic retrograde cholangiopancreatography revealed hilar cholangiocarcinoma with a Bismuth type III anatomical configuration (Figure 2). A guide wire (0.035−inch Jagwire; Microva− sive Boston Scientific, Natick, Massachu− setts, USA) was negotiated into the right biliary system. The first SEMS was de− ployed over this guide wire, with the wider mesh holes positioned below the bifurcation. A second Jagwire was then passed through the gap in the first SEMS into the left ductal system, over which the second SEMS was deployed in a "Y" fashion ( Figure 3). This is the first case re− port describing the placement of a Y bili− ary stent in a hilar biliary stricture. The patient was jaundice− and pruritis−free 10 weeks after the procedure. The Y stent appears to represent a technically easier option for the managment of malignant hilar biliary strictures.

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Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique

Cited by 101 publications

References 18 publications

Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Role of Palliative Endoscopic Drainage in Patients with Malignant Biliary Obstruction

Endoscopic biliary stenting for unresectable malignant hilar obstruction

A new biliary ”Y” stent for hilar tumors

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