Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures: A multicenter retrospective study

Jo, Ik Hyun; Paik, Chang Nyol; Kim, Dae Bum; Lee, Jaesin; Lee, Jong Yul; Chang, Jae Hyuck; Paik, Kyu-hyun; Park, Wonsuk

doi:10.1016/j.hbpd.2021.08.002

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…An important consideration is that the bilateral approach can be complex, and may lead to postoperative cholangitis, bleeding, and other complications. [20]…”

Section: Discussionmentioning

confidence: 99%

“…An important consideration is that the bilateral approach can be complex, and may lead to postoperative cholangitis, bleeding, and other complications. [20] Because unilateral SEMS deployment is less complex and less expensive, many patients with MHBO prefer this approach. Chemotherapy has increased the survival time of these patients, and this has increased the incidence of RBO.…”

Section: Discussionmentioning

confidence: 99%

“…[18] The necessity for bilateral or unilateral drainage for MHBO is controversial. [4,19,20] Some evidence suggests that bilateral drainage can drain more liver volume and reduce the incidence of cholangitis. [8,21] However, other evidence indicates that a unilateral approach can drain nearly 50% of the liver volume, which is sufficient for alleviation of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic reintervention after unilateral metal stent deployment for MHBO using SIS method

2023

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Endoscopic biliary drainage is the main treatment for unresectable malignant hilar biliary obstruction (MHBO). Recurrent biliary obstruction (RBO) often occurs after unilateral metal stent deployment. Endoscopic reintervention can be complex for this problem, especially for drainage of the contralateral bile duct. The stent-in-stent (SIS) method is a possible solution to this problem. Our objective was to evaluate the safety and feasibility of the SIS method for endoscopic reintervention in patients with RBO due to MHBO after unilateral metal stent deployment. Eleven patients with MHBO received endoscopic reintervention using the SIS method to manage RBO after unilateral metal stent deployment. Clinical data, including technical and clinical success, procedure time, adverse events and complications, stent patency, RBO of the revisionary stent, and survival time were recorded. Nine patients (82%) achieved technical success, and all 9 of them also achieved clinical success. The 2 unsuccessful cases received percutaneous transhepatic cholangial drainage. The median procedure time was 73 minutes. The 3 adverse events were post-endoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, and liver abscess. 6 patients (67%) experienced RBO of the revisionary stent, the median time to RBO of the revisionary stent was 95.5 days, the median survival time after reintervention was 111 days, and the median overall survival time was 305.5 days. Endoscopic reintervention after previous unilateral metal stent deployment using the SIS method appears to be safe and technically feasible for MHBO patients who experience RBO.

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“…An important consideration is that the bilateral approach can be complex, and may lead to postoperative cholangitis, bleeding, and other complications. [20]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic reintervention after unilateral metal stent deployment for MHBO using SIS method

2023

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“…Hilar strictures can be difficult to manage. Drainage with unilateral stenting has slowly shifted to bilateral stenting 8 . In rare cases (failed ERCP, altered anatomy, tumor preventing access into the biliary tree, or a contraindication to percutaneous access such as ascites), EUS-guided drainage via a transhepatic or transmural approach is necessary 9 …”

Section: General Managementmentioning

confidence: 99%

Ablation Therapy of the Biliary Tree

Kim,

Parekh,

Kahaleh

2024

Journal of Clinical Gastroenterology

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Malignant biliary obstruction is typically referred to endoscopists for palliation. A curative resection is indeed rarely an option in this condition. Photodynamic therapy and radiofrequency ablation are 2 modalities that can be offered in those patients. Many studies have demonstrated improved stent patency and survival after ablation. Photodynamic therapy is unfortunately very expensive and is associated with photosensitivity; however, it transmits to the entire biliary tree. Radiofrequency ablation is more affordable and easier to apply but requires contact with the tumor to be efficient. This review explores both modalities in terms of their safety and efficacy for bile duct cancer palliation.

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Radioactive versus normal stent insertion for malignant hilar obstruction: a meta-analysis

Chen¹,

Du³

et al. 2023

Minimally Invasive Therapy & Allied Technologies

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Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures: A multicenter retrospective study

Cited by 3 publications

References 19 publications

Endoscopic reintervention after unilateral metal stent deployment for MHBO using SIS method

Endoscopic reintervention after unilateral metal stent deployment for MHBO using SIS method

Ablation Therapy of the Biliary Tree

Radioactive versus normal stent insertion for malignant hilar obstruction: a meta-analysis

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