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Endoscopic revision efficacy after clinically successful bilateral metal stenting for advanced malignant hilar obstruction

Authors
 Tae Hoon Lee  ;  Sung Ill Jang  ;  Jong Ho Moon  ;  Yun Nah Lee  ;  Jae Kook Yang  ;  Jin-Seok Park  ;  Seok Jeong  ;  Don Haeng Lee  ;  Nam Hun Heo  ;  Sang-Heum Park  ;  Dong Ki Lee 
Citation
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol.35(12) : 2248-2255, 2020-12 
Journal Title
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 
ISSN
 0815-9319 
Issue Date
2020-12
Keywords
bilateral ; hilar ; metal ; obstruction ; reintervention
Abstract
Backgrounds and aim: Multiple insertions of self-expandable metal stents (SEMS) for advanced malignant hilar obstruction (MHO) are now considered to be an effective palliative method for adequate drainage of liver volume. However, the efficacy of endoscopic reintervention in technically and clinically successful bilateral SEMS is limited. This study investigated the endoscopic revision efficacy in patients who underwent bilateral SEMS in MHO. Methods: Primary endoscopic revision using plastic or metal stents or an alternative percutaneous approach followed by secondary endoscopic revision was performed in patients who underwent clinically successful deployment of bilateral SEMS. The primary outcome was a technical success. Secondary outcomes were clinical success, adverse events, and patency duration after reintervention. Results: A total of 55 patients (83.3%) out of 66 enrolled patients underwent reintervention: primary endoscopic reintervention (n = 47) and secondary endoscopic revision following percutaneous drainage (n = 8). Intended technical success rates of primary and secondary endoscopic reintervention were 93.6% (44/47) and 87.5% (7/8), respectively (P = 0.47). Clinical success rates were 72.3% and 50%, respectively (P = 0.23). Stent malfunction rate after reintervention was 48.9% (23/47) and 37.5% (3/8) (P = 0.70) during follow up, and median cumulative stent patency duration was 119 and 55 days, respectively (log-rank P = 0.68). Stent patent rate after reintervention was not different according to the time interval. In univariate and multivariate analysis for stent patency duration-related factors after reintervention, there were no meaningful factors. Conclusion: Primary endoscopic reintervention for bilateral SEMS in MHO was feasible technically and clinically. However, there were no statistically meaningful factors for stent patency duration after reintervention.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jgh.15123
DOI
10.1111/jgh.15123
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Jang, Sung Ill(장성일) ORCID logo https://orcid.org/0000-0003-4937-6167
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/181336
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