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A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy

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Abstract

Background

Few studies have reported the outcomes of self-expandable metal stent (SEMS) placement for malignant biliary obstruction in patients with surgically altered anatomy.

Aims

To evaluate the outcomes of biliary metal stent placement with the use of a short-type single-balloon enteroscope (working length, 1520 mm; channel diameter, 3.2 mm) in such patients.

Methods

We retrospectively studied 13 malignant biliary obstructions treated by SEMS placement. Technical success rate, functional success rate, time to recurrent biliary obstruction (RBO), and complications were evaluated.

Results

Technical success rate was 100 % (13/13), functional success rate was 92 % (12/13), and the median time to RBO was 247 days (95 % CI 205.6–285.5). Complications comprised mild pancreatitis in one patient. Uncovered SEMSs were placed in three obstructions, partially covered SEMS in five obstructions, and fully covered SEMSs in five obstructions. Three stents occluded (two ingrowths and one mucosal hyperplasia), and one symptomatic distal stent migration occurred after more than 30 days from placement.

Conclusions

A short-type single-balloon enteroscope was useful for the placement of various SEMS in this patient population with satisfactory outcomes.

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Acknowledgments

The authors were provided the prototype instruments used in this study from Olympus Medical Systems (Tokyo, Japan).

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Authors and Affiliations

  1. Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Hiroshi Yamauchi, Mitsuhiro Kida, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Hiroshi Imaizumi, Miyata Eiji, Rikiya Hasegawa & Wasaburo Koizumi

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  1. Hiroshi Yamauchi
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  2. Mitsuhiro Kida
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  3. Kosuke Okuwaki
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  4. Shiro Miyazawa
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  5. Tomohisa Iwai
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  6. Hiroshi Imaizumi
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  7. Miyata Eiji
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  8. Rikiya Hasegawa
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  9. Wasaburo Koizumi
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Corresponding author

Correspondence to Hiroshi Yamauchi.

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Electronic supplementary material

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Video 1

A Patient with Distal Biliary Obstruction Caused by Lymph node Recurrence After Surgery for Gastric Cancer (Case.6). Lymph node metastases directly invaded the duodenal papilla. Placement of a fully covered, self-expandable metal stent (SEMS) (BONA-SHIMSTENT®, 7 cm) was performed after cannulation (MP4 15723 kb)

Video 2

Covered SEMS Removal and Replacement (Case.6). The metal stent was obstructed by mucosal hyperplasia of the duodenum and ERC revealed multiple defect that was suspected stones and debris. The fully covered SEMS (BONA-SHIMSTENT®, 7 cm) was removed through the scope, using a mouse tooth forceps, and another fully covered SEMS (X-suit NIR® Stents, 8 cm) was placed (MP4 35966 kb)

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Yamauchi, H., Kida, M., Okuwaki, K. et al. A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy. Dig Dis Sci 61, 2436–2441 (2016). https://doi.org/10.1007/s10620-016-4148-8

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  • DOI: https://doi.org/10.1007/s10620-016-4148-8

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