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Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study

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Abstract

Background

Whether uni- or bilateral drainage should be performed for malignant hilar biliary obstruction remains a matter of debate. Moreover, endoscopic placement of bilateral metallic stents has been considered difficult and complicated. Although the Y-stent with a central wide-open mesh facilitates bilateral stent placement, it has limitations. This study evaluated the feasibility and efficacy of the Niti-S large cell D-type biliary stent (LCD) with a uniform large cell for both uni- and bilateral drainage of malignant hilar biliary obstruction.

Methods

From April 2008 to March 2009, a total of 12 consecutive patients with unresectable malignant hilar biliary obstruction of Bismuth type 2 or greater underwent placement of LCD. Before LCD placement, all the patients underwent endoscopic unilateral biliary drainage using a plastic stent or a nasobiliary drainage tube. If jaundice improved after the procedure, the plastic stent or nasobiliary drainage tube was replaced with the unilateral LCD. If jaundice did not resolve or contralateral cholangitis occurred, bilateral LCD placement was performed.

Results

Seven patients had unilateral and five patients had bilateral LCD placement. Technical success was achieved for all 12 patients. An early complication occurred for one patient (8%), and stent occlusion occurred for six patients (50%) because of tumor ingrowth (n = 4) or sludge (n = 2). These patients were managed by insertion of plastic stents (n = 4) or percutaneous transhepatic biliary drainage (n = 2). The median stent patency period was 202 days.

Conclusions

The newly designed endoscopic metallic stent may be feasible and effective for malignant hilar biliary obstruction, and endoscopic reintervention is relatively simple.

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Disclosures

Hirofumi Kogure, Hiroyuki Isayama, Yousuke Nakai, Takeshi Tsujino, Yukiko Ito, Keisuke Yamamoto, Suguru Mizuno, Hiroshi Yagioka, Kazumichi Kawakubo, Takashi Sasaki, Kenji Hirano, Naoki Sasahira, Minoru Tada, Masao Omata, and Kazuhiko Koike have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hirofumi Kogure, Hiroyuki Isayama, Yousuke Nakai, Keisuke Yamamoto, Suguru Mizuno, Hiroshi Yagioka, Kazumichi Kawakubo, Takashi Sasaki, Kenji Hirano, Naoki Sasahira, Minoru Tada, Masao Omata & Kazuhiko Koike

  2. Department of Gastroenterology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan

    Takeshi Tsujino & Yukiko Ito

Authors
  1. Hirofumi Kogure
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  2. Hiroyuki Isayama
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  3. Yousuke Nakai
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  4. Takeshi Tsujino
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  5. Yukiko Ito
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  6. Keisuke Yamamoto
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  7. Suguru Mizuno
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  8. Hiroshi Yagioka
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  9. Kazumichi Kawakubo
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  10. Takashi Sasaki
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  11. Kenji Hirano
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  12. Naoki Sasahira
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  13. Minoru Tada
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  14. Masao Omata
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  15. Kazuhiko Koike
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Corresponding author

Correspondence to Hirofumi Kogure.

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Kogure, H., Isayama, H., Nakai, Y. et al. Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study. Surg Endosc 25, 463–467 (2011). https://doi.org/10.1007/s00464-010-1194-8

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  • DOI: https://doi.org/10.1007/s00464-010-1194-8

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