Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

Li, Mingwu; Bai, Ming; Qi, Xingshun; Li, Kai; Yin, Zhihua; Wang, Jianhong; Wu, Wenbing; Zhen, Luanluan; He, Chuangye; Fan, Daiming; Zhang, Zhuoli; Han, Guohong

doi:10.1007/s00270-014-0992-0

Cited by 36 publications

(31 citation statements)

References 35 publications

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“…15 In a recent work of percutaneous transhepatic biliary metal stenting for malignant hilar obstruction looking at predictive factors for efficacy in 159 patients from a single center, Li and colleagues reported a technical success rate of 100% and a clinical success of 71.4%. 16 These outcomes are similar to ours, except that clinical success in Li’s study was defined by a decrease of only 30% at 7 days. Morbidity results from Li’s study (26.4%) suggest more severe and more frequent complications than after EUBD.…”

Section: Discussionsupporting

confidence: 78%

Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction?

Moryoussef

Sportes

Leblanc

et al. 2017

Therap Adv Gastroenterol

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Background:Results of endoscopic ultrasound-guided biliary drainage (EUBD) are unknown in case of proximal stricture. The aim is to assess clinical outcomes of EUBD in patients with malignant hilar obstruction.Methods:Patients undergoing EUBD with hilar strictures were prospectively included. Primary outcome was clinical success at 7 and 30 days (defined by 50% bilirubin decrease). Secondary outcomes were technical success, procedure-related complications, length of hospital stay, reintervention rate, survival and chemotherapy administration.Results:Eighteen patients with a mean age of 68.8 years were included. On 15 classable stenosis, 7 (47%) were noted Bismuth I–II, 7 (47%) Bismuth III, and 1 (6.7%) Bismuth IV. Reasons for EUBD were surgically modified anatomy in 10 patients (55.6%), impassable stricture at ERCP in 7 (38.9%) and duodenal obstruction in 1 (5.6%). Only hepaticogastrostomy was performed. Clinical success was at day 7 and 30 respectively 72.2% and 68.8%. Technical success was 94%. Complications occurred in 3 (16.7%) patients. Median (range) length of hospital stay was 10 (6–35) days. Reintervention rate was 16.7%. Median (range) survival was 79 (5–390) days. Chemotherapy was possible in 10 (55.6%) patients.Conclusions:EUBD is feasible for hilar obstruction for surgically altered anatomy or after ERCP failure. Clinical outcome is satisfactory when considering underlying advanced disease, allowing chemotherapy.

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Section: Discussionsupporting

confidence: 78%

Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction?

Moryoussef

Sportes

Leblanc

et al. 2017

Therap Adv Gastroenterol

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“…We developed a new risk score including 5 independent predictor indexes to help predict survival. In a previous study, we focused on the efficacy of successful drainage and predictors of malignant hilar obstruction (20). In the present study, we focused on stent patency, survival, predictors of stent patency and survival, and identification of patient subgroups who might benefit the most from stent implantation.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure for metal stent placement in the presence of obstructive hilar malignancy has been previously described by our team (20). The procedure was performed under local anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

et al. 2016

Journal of Vascular and Interventional Radiology

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“…In addition, percutaneous external drainage prior to stent insertion was performed in 18 patients (30.5%) in the current study, which may change clinical outcomes, even though data show that stent placement with or without preoperative biliary drainage did not significantly affect therapeutic success, major complications, or stent patency. [ 27 ] However, these results are limited by the small sample size. Further randomized controlled studies with larger sample size is needed to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

Zhang

Liu

et al. 2018

Saudi J Gastroenterol

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Background/Aims:Metal stent insertion is a common palliative treatment for distal malignant biliary obstruction (MBO) but whether placement across the sphincter of Oddi (SO) causes more complications or shorter survival is in question. The aim of this study was to compare the clinical outcomes of percutaneous uncovered self-expandable metal stent placement above and across the SO in patients with distal MBO.Patients and Methods:We retrospectively studied 59 patients who underwent uncovered metal stent placement for distal MBO between January 2012 and March 2016. Stents were placed above the SO for 22 subjects (group A) and across the SO for 37 subjects (group B). Early cholangitis, stent occlusion, and overall survival time were compared between the two groups.Results:Clinical success was 90.9 and 86.5% for groups A and B, respectively. Early cholangitis occurred in 2 patients (9.1%) in group A and in 6 patients (16.2%) in group B (P = 0.645). Median stent patency and median survival time was 105 and 140 days for group A, 120 and 160 days for group B, respectively. The stent occlusion (31.8% in group A and 21.6% in group B, P = 0.454) and the cumulative stent patency times (P = 0.886) did not differ between the two groups. There was no significant difference in cumulative patient survival between the two groups (P = 0.810).Conclusion:Uncovered metal stent placement across the SO did not significantly affect early cholangitis, stent patency, or patient survival.

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Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

Abstract: The majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.

Cited by 36 publications

References 35 publications

Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction?

Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction?

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

Differences in efficacy of uncovered self-expandable metal stent in relation to placement in the management of malignant distal biliary obstruction

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