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SEMS Insertion for Hilar Stricture: Which Stent, How and Why?

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Advanced ERCP for Complicated and Refractory Biliary and Pancreatic Diseases

Abstract

Endoscopic management of unresectable malignant hilar strictures via placement of self-expandable metallic stents (SEMSs) remains challenging and is not yet fully established. Half of the liver must be drained to retain liver function and extend the time to recurrence of biliary obstruction. There are two principal modes of SEMS insertion: stent-in-stent (SIS) and side-by-side (SBS). The SBS techniques for stent insertion and reintervention are easier to apply than those of SIS, but extensive dilation of the common bile when the SBS technique is used may cause complications. Some special SEMSs for SIS insertion via the mesh technique are available. It remains unclear whether SEMSs should be placed above or across the papilla; however, when using the SBS technique for re-intervention, the latter approach is easier. Covered SEMSs for hilar strictures were previously unavailable, but a slim (6-mm diameter)-covered SEMS has been used to treat hilar strictures recently; this SEMS remains under evaluation. Thus, various SEMSs and techniques are available for the management of hilar stricture; no optimal combination has yet been accepted.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Hiroyuki Isayama, Toshio Fujisawa, Shigeto Ishii, Hiroaki Saito, Akinori Suzuki, Yusuke Takasaki, Sho Takahashi, Hirofumi Kogure & Yousuke Nakai

  2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroyuki Isayama, Toshio Fujisawa, Shigeto Ishii, Hiroaki Saito, Akinori Suzuki, Yusuke Takasaki, Sho Takahashi, Hirofumi Kogure & Yousuke Nakai

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  1. Hiroyuki Isayama
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  2. Toshio Fujisawa
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  3. Shigeto Ishii
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  4. Hiroaki Saito
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  5. Akinori Suzuki
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  6. Yusuke Takasaki
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  7. Sho Takahashi
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  8. Hirofumi Kogure
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  9. Yousuke Nakai
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Correspondence to Hiroyuki Isayama .

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Editors and Affiliations

  1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Dong Ki Lee

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Isayama, H. et al. (2020). SEMS Insertion for Hilar Stricture: Which Stent, How and Why?. In: Lee, D. (eds) Advanced ERCP for Complicated and Refractory Biliary and Pancreatic Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-13-0608-2_6

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  • DOI: https://doi.org/10.1007/978-981-13-0608-2_6

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-0607-5

  • Online ISBN: 978-981-13-0608-2

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