Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: Efficacy of self-expandable metallic Wallstents

Cheng, J.; Bruno, Marco J.; Bergman, Jacques J.G.H.M.; Rauws, Erik A.; Tytgat, G. N. J.; Huibregtse, K.

doi:10.1067/mge.2002.125364

Cited by 192 publications

(136 citation statements)

References 21 publications

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“…In patients with unresectable disease, biliary drainage was accomplished by definitive internal stenting by PTC or ERCP using metal expandable stents, usually within the same hospital admission. 10,11 The Modified Clavien-Dindo system was used to grade complications; grades I and II represented minor and grades III, IV, and V represented major complications. 12 …”

Section: Laparotomy and Resectionmentioning

confidence: 99%

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Ruys

Busch

Gouma

et al. 2012

Indian J Surg Oncol

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Purpose. This study was designed to evaluate the benefit of staging laparoscopy (SL) in patients with suspected hilar cholangiocarcinoma (HCCA) during the past 10 years. Only 50-60% of patients with HCCA who undergo laparotomy are ultimately amenable to a potentially curative resection. In a previous study, we recommended routine use of SL to prevent unnecessary laparotomies. The accuracy of imaging techniques, however, has significantly improved during the past decade, which is likely to impact the yield and accuracy of SL. Methods. From 2000 to 2010, 195 patients with suspected HCCA were analyzed. The yield and accuracy of SL were calculated by dividing total number of avoided laparotomies by the total number of laparoscopies or by all patients with unresectable disease, respectively. Factors associated with better yield and accuracy were assessed. Results. Of 195 patients with HCCA, 175 underwent SL. The yield of SL was 14% and the accuracy was 32%. Operative morbidity of SL was 3%, and operative morbidity of laparotomy for unresectable disease was 33%. No clear factors that influenced the yield of SL were found. Conclusion. Overall yield and accuracy of SL for HCCA in the present series decreased to 14% and 32%, respectively, compared with earlier reports. This finding is likely the result of improved imaging techniques that evolved during the past decade. The place of SL in the workup of patients with HCCA needs to be reconsidered, and one should decide whether the declining additional value of SL still outweighs the drawbacks of SL.

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Section: Laparotomy and Resectionmentioning

confidence: 99%

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Ruys

Busch

Gouma

et al. 2012

Indian J Surg Oncol

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“…In biliary obstruction in the hepatic hilum, effective drainage is difficult to achieve because of the anatomical complexity of the bile ducts. Various procedures of biliary drainage of hilar biliary obstruction have been performed: percutaneous or endoscopic routes [1][2][3][4][5] , plastic or metallic stents [6][7][8][9][10][11] , and unilateral or bilateral hepatic duct drainage [11][12][13][14][15][16][17][18][19][20][21] . However, no consensus has been reached on the optimal drainage strategy for treating biliary obstruction.…”

Section: Introductionmentioning

confidence: 99%

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

Takahashi

Fukasawa

Satô

et al. 2015

WJG

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AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures (UMHBS) because no ideal strategy currently exists. METHODS:We examined 78 patients with UMHBS who underwent biliary drainage. Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention. Complications that occurred within 7 d after stent placement were considered as early complications. Before drainage, the liver volume of each section (lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography (CT) volumetry. Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture (according to the Bismuth classification). Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section. Receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff values for drained liver volume. In addition, factors associated with the effectiveness of drainage and early complications were evaluated. cirrhosis) and 50% for patients with impaired liver function (with decompensated liver cirrhosis). The sensitivity and specificity of these cutoff values were 82% and 80% for preserved liver function, and 100% and 67% for impaired liver function, respectively. Among patients who met these criteria, the rate of effective drainage among those with preserved liver function and impaired liver function was 90% and 80%, respectively. The rates of effective drainage in both groups were significantly higher than in those who did not fulfill these criteria (P < 0.001 and P = 0.02, respectively). Drainage-associated cholangitis occurred in 9 patients (12%). A smaller drained liver volume was associated with drainage-associated cholangitis (P < 0.01). RESULTS: CONCLUSION:Liver volume drainage ≥ 33% in patients with preserved liver function and ≥ 50% in patients with impaired liver function correlates with effective biliary drainage in UMHBS. Core tip: An ideal biliary drainage strategy for unresectable malignant hilar biliary strictures (UMHBS) has not been defined. The aim of our study was to identify useful criteria for predicting successful drainage of UMHBS. In the present study, multivariate analysis revealed that liver function and drained liver volume calculated by computed tomography volumetry (CTV) are independent factors of drainage effectiveness for UMHBS. Receiver operating characteristic analysis showed cutoff values of 33% of liver volume for patients with preserved liver function and 50% for patients with impaired liver function. Before attempting biliary drainage procedures, establishing an appropriate drainage strategy using CTV is important.Takahashi E, Fukasawa M, Sato T, Takano S, Kadokura M, Shindo H, Yokota Y, Enomoto N. Biliary drainage strategy of unresectable malignant hilar strictures by...

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“…4,59 In a retrospective review of 52 SEMS in 35 patients by Cheng et al, five (14%) patients with SEMS had complications, including cholangitis or early stent closure when stenting unresectable hilar cholangiocarcinoma. 4,60 Park et al studied an unusual stent with similar results. He inserted a Bonastent M-Hilar SEMS with a cross wired nitinol mesh into 34 patients with unresectable malignant hilar biliary strictures of Bismuth type II or higher.…”

Section: Plastic Vs Metal Stentingmentioning

confidence: 80%

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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Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: Efficacy of self-expandable metallic Wallstents

Cited by 192 publications

References 21 publications

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile?

Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

An Update to Hepatobiliary Stents

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