Triple stent-in-stent placement of novel braided metal stents with a slim delivery system via balloon-assisted enteroscopy

Shimoda, Tatsuya; Kogure, Hirofumi; Nakai, Yousuke; Ishigaki, Kazunaga; Hakuta, Ryunosuke; Saito, Kei; Koike, Kazuhiko

doi:10.1055/a-1492-1911

Cited by 3 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, a braided-type SEMS has a stronger extended force than a laser-type SEMS. Second, a longer effective length of the delivery system is suitable for stenting in MHBO patients with a past history of abdominal surgery [ 16 , 17 ]. Third, the Niti-S large-cell SR slim delivery is suitable for a 0.025 guidewire, and there is almost no step between the guidewire and the tip of the delivery system.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a novel large-cell Niti-S stent with a slim delivery system for hilar biliary obstruction: a preliminary study

et al. 2022

View full text Add to dashboard Cite

Objectives The large-cell Niti-S stent is useful for multiple stenting in patients with malignant hilar biliary obstruction (MHBO). Recently, a novel uncovered self-expandable metallic stent (USEMS) (a Niti-S large-cell SR slim delivery system) was developed. In this study, we aimed to evaluate the efficacy of this USEMS slim delivery system in MHBO patients. Materials and methods Outcomes related to USEMS placement, the clinical course, and the period to recurrent biliary obstruction (RBO) were evaluated in MHBO patients who received multiple USEMSs with the Niti-S large-cell SR slim delivery system. Results Twenty-two MHBO patients underwent the placement of multiple USEMSs, including the novel slim-delivery stent. Six patients had a past history of upper gastrointestinal reconstruction (Billroth I: 1, Billroth II: 4, Roux-en-Y: 1). The number of USEMSs placed in each patient was 2-6. Three procedures were reinterventions. The new slim delivery system was placed as the first stent in ten patients and as an additional stent in the remaining patients. Seven patients were drained using only Niti-S large-cell SR slim delivery stents. The technical and clinical success rates were both 100%. Conclusions Placing multiple USEMSs in patients with a past history of abdominal surgery or in reintervention is difficult. Although difficult cases were included in this study, stent-in-stent placement with the novel Niti-S large-cell SR slim delivery system was useful in treating MHBO patients. In addition, this novel stent might be the first choice for MHBO patients. KEY MESSAGES Endoscopic multistenting for MHBO is challenging. In addition, reintervention or multistenting for MHBO patients with a past history of abdominal surgery becomes more difficult. The novel Niti-S large-cell SR slim delivery USEMS is useful as an additional stent because the delivery system is thin and suitable for a 0.025 guidewire. In addition, the novel stent is of the braided type and has a large mesh. Therefore, the novel stent is expected to have strong radial force and can be used as the first SEMS. The Niti-S large-cell SR slim delivery stent is long enough to be used in patients with upper gastrointestinal reconstruction. Although this study included patients with reintervention or a past history of upper gastrointestinal reconstruction, the technical success rate of multiple stenting for MHBO patients was 100%. The slim-delivery stent might overcome several difficulties of endoscopic multistenting.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of a novel large-cell Niti-S stent with a slim delivery system for hilar biliary obstruction: a preliminary study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…We previously reported a high technical success rate of the SIS method using large-cell stents with an 8.5F stent delivery, 9,19 and this large-cell stent was recently modified with a tapered-tip, 6F delivery system to facilitate stent delivery insertion through the stricture and the stent mesh. [20][21][22] In this retrospective comparative study, we compared SIS methods using new large-cell stents with a slim-delivery system and conventional large-cell stents for unresectable HMBO.…”

Section: Introductionmentioning

confidence: 99%

“…However, multiple stent placement by the SIS method can be technically demanding at the time of the second stent delivery passage through the first stent, and dedicated stents such as large‐cell type or moving cell type 18 stents have been investigated. We previously reported a high technical success rate of the SIS method using large‐cell stents with an 8.5F stent delivery, 9,19 and this large‐cell stent was recently modified with a tapered‐tip, 6F delivery system to facilitate stent delivery insertion through the stricture and the stent mesh 20–22 . In this retrospective comparative study, we compared SIS methods using new large‐cell stents with a slim‐delivery system and conventional large‐cell stents for unresectable HMBO.…”

Section: Introductionmentioning

confidence: 99%

Retrospective comparative study of new slim‐delivery and conventional large‐cell stents for stent‐in‐stent methods for hilar malignant biliary obstruction

Ishigaki

Fukuda

Nakai

et al. 2023

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

ObjectivesEndoscopic management of unresectable hilar malignant biliary obstruction (HMBO) is technically challenging, and effectiveness of stent‐in‐stent using large‐cell, metal stents was reported. A new, large‐cell stent with a 6F tapered delivery system was recently developed. The aim of this study was to compare clinical outcomes of slim‐delivery and conventional large‐cell stents.MethodsThis was a multicenter retrospective comparative study of stent‐in‐stent methods using slim‐delivery stents (Niti‐S Large Cell SR Slim Delivery [LC slim‐delivery]) and conventional stents (Niti‐S large‐cell D‐type; LCD) for unresectable HMBO.ResultsEighty‐three patients with HMBO were included; 31 LC slim‐delivery and 52 LCD. Overall technical and clinical success rates were 100% and 90% in LC slim‐delivery group and 98% and 88% in LCD group. Use of the LC slim‐delivery was associated with shorter stent placement time in the multiple regression analysis, with a stent placement time of 18 and 23 min in LC slim‐delivery and LCD groups, respectively. The early adverse event (AE) rate of LC slim‐delivery was 10%, with no cholangitis or cholecystitis as compared to 23% in the LCD group. Recurrent biliary obstruction (RBO) rates and time to RBO were comparable between the two groups: 35% and 44%, and 8.5 and 8.0 months in LC slim‐delivery and LCD groups, respectively. The major cause of RBO was tumor ingrowth (82%) in the LC slim‐delivery group and sludge (43%) and ingrowth (48%) in LCD group.ConclusionStent‐in‐stent methods using LC slim‐delivery shortened stent placement time with low early AE rates and comparable time to RBO in patients with HMBO.

show abstract

“…Considering that transhepatic approaches such as percutaneous drainage or endoscopic ultrasound-guided hepaticogastrostomy 1 are invasive, we chose endoscopic retrograde cholangiopancreatography (ERCP) to take advantage of the natural orifice route, which is less invasive even in surgically altered anatomy. [2][3][4] With the aim to reduce the stress on the reconstructed intestinal tract, ERCP was performed using a front viewing enteroscope equipped with passive bending and high-force transmission (SIF-H290S; Olympus Medical Systems) without a balloon-assisted system (Figure 1B-E and Video S1) because the taut bands or adhesions of the intestinal tract after surgery were not clear in computed tomography images. The enteroscope was shorter than a conventional one and had a working length of 152 cm and 3.2 mm working channel.…”

mentioning

confidence: 99%

Endoscopic selective biliary stenting and reintervention using metal stents with a slim delivery system in a patient with complexly altered digestive anatomy

Nishikawa

Kamiya

Takeuchi

2021

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Nishikawa and colleagues describe a case of endoscopic multiple stenting for malignant biliary stenosis in a patient with complexly altered digestive anatomy following hepaticojejunostomy with Roux‐en‐Y anastomosis and gastrojejunostomy with Braun enterostomy. Furthermore, reintervention for malignant stenosis extending from the intrahepatic bile duct to the intestinal tract was successfully completed.

show abstract

Triple stent-in-stent placement of novel braided metal stents with a slim delivery system via balloon-assisted enteroscopy

Abstract: Video 1 Triple stent-in-stent placement of novel braided metal stents with a slim delivery system via balloon-assisted enteroscopy for hilar malignant biliary obstruction.

Cited by 3 publications

References 5 publications

Efficacy of a novel large-cell Niti-S stent with a slim delivery system for hilar biliary obstruction: a preliminary study

Efficacy of a novel large-cell Niti-S stent with a slim delivery system for hilar biliary obstruction: a preliminary study

Retrospective comparative study of new slim‐delivery and conventional large‐cell stents for stent‐in‐stent methods for hilar malignant biliary obstruction

Endoscopic selective biliary stenting and reintervention using metal stents with a slim delivery system in a patient with complexly altered digestive anatomy

Contact Info

Product

Resources

About