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Clinical Outcomes of Bilateral Stent-in-Stent Placement Using Self-Expandable Metallic Stent for High-Grade Malignant Hilar Biliary Obstruction

Authors
 Ja Yoon Heo  ;  Hee Seung Lee  ;  Jun Hyuk Son  ;  Sang Hyub Lee  ;  Seungmin Bang 
Citation
 YONSEI MEDICAL JOURNAL, Vol.59(7) : 827-833, 2018 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2018
MeSH
Adult ; Aged ; Bile Duct Neoplasms/complications* ; Bile Duct Neoplasms/surgery ; Carcinoma/complications* ; Carcinoma/surgery ; Cholestasis/etiology ; Cholestasis/therapy* ; Drainage/methods ; Endoscopy, Digestive System/methods* ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prosthesis Implantation/methods* ; Risk Factors ; Self Expandable Metallic Stents* ; Stents/adverse effects ; Treatment Outcome
Keywords
Malignant hilar biliary obstruction ; self-expandable metallic stent ; stent patency ; stent-in-stent
Abstract
PURPOSE: Endoscopic bile duct decompression using bilateral self-expandable metallic stents (SEMSs) deployed via a stent-in-stent (SIS) method is considered a preferred procedure for malignant hilar biliary obstruction (MHBO). However, occlusion thereof occurs frequently. Here, we investigated stent patency duration and risk factors related to stent obstruction with bilateral SIS placement for MHBO at two large centers. MATERIALS AND METHODS: The present study reviewed data on patients with MHBO who underwent endoscopic biliary drainage using the SIS method. Clinical outcomes, including stent patency duration and patient overall survival, were analyzed. Factors associated with stent patency were evaluated using Cox proportional hazards models. RESULTS: Seventy patients with MHBO underwent endoscopic biliary drainage using the SIS method. Median age was 68 years old, and median follow-up duration was 140 days (interquartile range, 57-329). The proportion of high-grade MHBOs (Bismuth type IV) was 57.1%. Median stent patency duration with the SIS method was 108 days according to Kaplan-Meier curves. Median patient survival analyzed by the Kaplan-Meier method was 181 days. Multivariate analysis indicated that higher baseline bilirubin (> 6.1 mg/dL) as an independent risk factor related to stent patency (p<0.05). CONCLUSION: In endoscopic biliary decompression using SEMS placed with the SIS method, obstructive jaundice was a risk factor for stent patency. The SIS method for high-grade MHBO showed short stent patency.
Files in This Item:
T201805427.pdf Download
DOI
10.3349/ymj.2018.59.7.827
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Bang, Seungmin(방승민) ORCID logo https://orcid.org/0000-0001-5209-8351
Lee, Hee Seung(이희승) ORCID logo https://orcid.org/0000-0002-2825-3160
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167260
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