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Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors

Authors
 Sung Ill Jang  ;  Jin-Hyeok Hwang  ;  Kwang-Hun Lee  ;  Jeong-Sik Yu  ;  Hee Wook Kim  ;  Chang Jin Yoon  ;  Yoon Suk Lee  ;  Kyu Hyun Paik  ;  Sang Hyub Lee  ;  Dong Ki Lee 
Citation
 Journal of Gastroenterology and Hepatology, Vol.32(4) : 932-938, 2017 
Journal Title
 Journal of Gastroenterology and Hepatology 
ISSN
 0815-9319 
Issue Date
2017
MeSH
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/therapy* ; Bile Ducts, Intrahepatic* ; Drainage/methods* ; Endoscopy* ; Female ; Humans ; Male ; Middle Aged ; Palliative Care/methods* ; Retrospective Studies ; Stents* ; Treatment Failure ; Treatment Outcome
Keywords
biliary drainage ; endoscopic stenting ; hilar tumor ; percutaneous stenting ; self-expandable metal stent
Abstract
BACKGROUND AND AIM: Palliative endoscopic or percutaneous biliary drainage is used for unresectable advanced hilar cancer (HC). The best option for drainage in Bismuth type III or IV HC has not been established. The aims of this study are to identify factors predictive of endoscopic stenting failure and evaluate the effectiveness of rescue percutaneous stenting in patients with advanced HC. METHODS: Data from 110 patients with inoperable advanced HC were retrospectively reviewed. All received bilateral self-expandable metallic stents. Patients were divided into three groups: I, successful initial endoscopic stenting; II, unsuccessful initial endoscopic stenting, followed by percutaneous stenting; and III, initial percutaneous stenting. We analyzed clinical results and radiologic tumor characteristics. RESULTS: Baseline characteristics and clinical outcomes of all groups were similar, except the hospital stay was longer in group III than group I. Technical success rate was higher in groups II and III (100%) than in group I (72.4%). The functional success rate, stent patency time, patient survival time, and complication rate were similar between groups. Endoscopic stenting failed because of guide-wire passage failure (n = 12) or stent passage failure (n = 7). The only factor significantly associated with endoscopic failure was a smaller left intrahepatic duct-common bile duct angle. CONCLUSIONS: As clinical outcomes were generally similar between approaches, percutaneous stenting is recommended for patients with Bismuth type III or IV advanced HC. Acute left intrahepatic duct-common bile duct angulation predicts endoscopic stenting failure. If endoscopic stenting fails, immediate conversion to the percutaneous approach is a necessary and effective rescue method.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/jgh.13602/abstract
DOI
10.1111/jgh.13602
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김희욱(Kim, Hee Wook)
유정식(Yu, Jeong Sik) ORCID logo https://orcid.org/0000-0002-8171-5838
이광훈(Lee, Kwang Hun)
이동기(Lee, Dong Ki) ORCID logo https://orcid.org/0000-0002-0048-9112
장성일(Jang, Sung Ill) ORCID logo https://orcid.org/0000-0003-4937-6167
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154510
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