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Digestive Diseases and Sciences

, Volume 62, Issue 9, pp 2542–2549 | Cite as

Simultaneous Versus Sequential Side-by-Side Bilateral Metal Stent Placement for Malignant Hilar Biliary Obstructions

  • Tadahisa InoueEmail author
  • Norimitsu Ishii
  • Yuji Kobayashi
  • Rena Kitano
  • Kazumasa Sakamoto
  • Tomohiko Ohashi
  • Yukiomi Nakade
  • Yoshio Sumida
  • Kiyoaki Ito
  • Haruhisa Nakao
  • Masashi Yoneda
Original Article

Abstract

Background

Endoscopic bilateral self-expandable metallic stent (SEMS) placement for malignant hilar biliary obstructions (MHBOs) is technically demanding, and a second SEMS insertion is particularly challenging. A simultaneous side-by-side (SBS) placement technique using a thinner delivery system may mitigate these issues.

Aims

We aimed to examine the feasibility and efficacy of simultaneous SBS SEMS placement for treating MHBOs using a novel SEMS that has a 5.7-Fr ultra-thin delivery system.

Methods

Thirty-four patients with MHBOs underwent SBS SEMS placement between 2010 and 2016. We divided the patient cohort into those who underwent sequential (conventional) SBS placement between 2010 and 2014 (sequential group) and those who underwent simultaneous SBS placement between 2015 and 2016 (simultaneous group), and compared the groups with respect to the clinical outcomes.

Results

The technical success rates were 71% (12/17) and 100% (17/17) in the sequential and simultaneous groups, respectively, a difference that was significant (P = .045). The median procedure time was significantly shorter in the simultaneous group (22 min) than in the sequential group (52 min) (P = .017). There were no significant group differences in the time to recurrent biliary obstruction (sequential group: 113 days; simultaneous group: 140 days) or other adverse event rates (sequential group: 12%; simultaneous group: 12%).

Conclusions

Simultaneous SBS placement using the novel 5.7-Fr SEMS delivery system may be more straightforward and have a higher success rate compared to that with sequential SBS placement. This new method may be useful for bilateral stenting to treat MHBOs.

Keywords

Self-expandable metallic stent Bilateral drainage Malignant hilar biliary obstruction Side-by-side placement 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

Video 1

Sequential side-by-side placement of self-expandable metallic stents for high-grade malignant hilar biliary obstruction. After inserting 2 guidewires into the left and right intrahepatic bile ducts, the first stent was inserted and placed in the right hepatic duct. Next, the second stent was inserted and placed in the left hepatic duct alongside the first stent over the other guidewire. (MPG 33610 kb)

Video 2

Simultaneous side-by-side self-expandable metallic stent placement for high-grade malignant hilar biliary obstruction. After inserting 2 guidewires into the left and right intrahepatic bile ducts, 2 5.7-Fr delivery systems were simultaneously inserted over each guidewire through the duodenoscope’s 4.2-mm working channel. Next, 2 stents were simultaneously placed in a side-by-side configuration, aligning the distal stent ends above the duodenal papilla. (MPG 41932 kb)

References

  1. 1.
    Sawas T, Al Halabi S, Parsi MA, Vargo JJ. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc. 2015;82:256–267.CrossRefPubMedGoogle Scholar
  2. 2.
    Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol. 2017;112:260–273.CrossRefPubMedGoogle Scholar
  3. 3.
    Kato H, Tsutsumi K, Kawamoto H, Okada H. Current status of endoscopic biliary drainage for unresectable malignant hilar biliary structures. World J Gastrointest Endosc. 2015;7:1032–1038.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kawakami H, Itoi T, Kuwatani M, Kawakubo K, Kubota Y, Sakamoto N. Technical tips and troubleshooting of endoscopic biliary drainage for unresectable malignant hilar biliary obstruction. J Hepatobiliary Pancreat Sci. 2015;22:E12–E21.CrossRefPubMedGoogle Scholar
  5. 5.
    Moon JH, Rerknimitr R, Kogure H, Nakai Y, Isayama H. Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques. J Hepatobiliary Pancreat Sci. 2015;22:650–656.CrossRefPubMedGoogle Scholar
  6. 6.
    Chennat J, Waxman I. Initial performance profile of a new 6F self-expanding metal stent for palliation of malignant hilar biliary obstruction. Gastrointest Endosc. 2010;72:632–636.CrossRefPubMedGoogle Scholar
  7. 7.
    Law R, Baron TH. Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and side-by-side stent deployment. Dig Dis Sci. 2013;58:2667–2672.CrossRefPubMedGoogle Scholar
  8. 8.
    Kawakubo K, Kawakami H, Kuwatani M, et al. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study. J Hepatobiliary Pancreat Sci. 2015;22:151–155.CrossRefPubMedGoogle Scholar
  9. 9.
    Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg. 1988;12:39–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2015;27:259–264.CrossRefPubMedGoogle Scholar
  11. 11.
    Mukai T, Yasuda I, Nakashima M, et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci. 2013;20:214–222.CrossRefPubMedGoogle Scholar
  12. 12.
    Vienne A, Hobeika E, Gouya H, et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc. 2010;72:728–735.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee TH, Moon JH, Park SH. Bilateral metallic stenting in malignant hilar obstruction. Clin Endosc. 2014;47:440–446.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci. 2012;57:3279–3285.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim KM, Lee KH, Chung YH, et al. A comparison of bilateral stenting methods for malignant hilar biliary obstruction. Hepatogastroenterology. 2012;59:341–346.CrossRefPubMedGoogle Scholar
  16. 16.
    Kogure H, Isayama H, Nakai Y, et al. High single-session success rate of endoscopic bilateral stent-in-stent placement with modified large cell Niti-S stents for malignant hilar biliary obstruction. Dig Endosc. 2014;26:93–99.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee TH, Park DH, Lee SS, et al. Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: a multicenter prospective study. Dig Dis Sci. 2013;58:547–555.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Tadahisa Inoue
    • 1
    Email author
  • Norimitsu Ishii
    • 1
  • Yuji Kobayashi
    • 1
  • Rena Kitano
    • 1
  • Kazumasa Sakamoto
    • 1
  • Tomohiko Ohashi
    • 1
  • Yukiomi Nakade
    • 1
  • Yoshio Sumida
    • 1
  • Kiyoaki Ito
    • 1
  • Haruhisa Nakao
    • 1
  • Masashi Yoneda
    • 1
  1. 1.Department of GastroenterologyAichi Medical University School of MedicineNagakuteJapan

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