Percutaneous Biliary Metallic Stent Placement in Patients With Unilobar Portal Vein Occlusion Caused by Advanced Hilar Malignancy: Outcome of Unilateral Versus Bilateral Stenting

Abstract

Unilateral biliary metallic stent placement in the lobe with a patent portal vein seems to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients.

Endoscopic stenting for malignant hilar biliary obstruction

“…However, Iwano et al [6] failed to find any significant benefits of bilateral drainage on stent patency time and survival. However, hepatic lobar atrophy frequently co-occurs with hilar cholangiocarcinoma and has been reported to occur in 20-30% of patients with this diagnosis [18]. However, hepatic lobar atrophy frequently co-occurs with hilar cholangiocarcinoma and has been reported to occur in 20-30% of patients with this diagnosis [18].…”

Percutaneous unilateral placement of biliary covered metallic stent in patients with malignant hilar biliary obstruction and contralateral portal vein occlusion

“…When the portal Fig. 6 Kaplan-Meier curve of the stent patency rate vein of one liver lobe is obstructed, portal vein obstruction interrupts the cycle of enterohepatic circulation in the obstructed lobe (14,15). Previous investigators reported successful treatment of bile leakage by selective portal vein embolization, which induces cessation of bile production (26,27).…”

Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist

“…30,33 SEMS placement is generally performed within 1 to 2 weeks after PTBD and relieves jaundice or cholangitis. 8,13,22 Access Route Bilateral (multiple) percutaneous routes Bilateral (multiple) percutaneous routes allow for easy handling and negotiation of a guidewire into the common bile duct (CBD) through the stricture caused by the tumor. SEMS placement via bilateral access is also technically simple.…”

“…It is generally performed using the stent-in-stent technique (T configuration or Y configuration) or the side-by-side technique. 8,12,13,22,[25][26][27][28] In addition, the crisscross technique has been reported as being a useful method for trisegmental drainage. 10 The side-to-end technique is also useful for multiple SEMS placement.…”

“…5 Percutaneous or endoscopic placement of a metallic stent is a well-established palliative treatment for advanced hilar malignancy. [6][7][8][9][10][11][12][13] Although there have been many studies on the outcome of unilateral and bilateral stent placement in patients with advanced hilar malignancy according to the Bismuth-Corlette classification, [11][12][13][14][15][16][17] there is no definitive consensus on the best stent placement method. The decision on whether to perform unilateral or bilateral stent placement depends on the extent of the malignant biliary stricture and on the degree of biliary tract contamination.…”