Efficacy of Endoscopic Bilateral Biliary Metal Stent Placement for Malignant Hilar Biliary Obstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GAO Daojian , HU Bing , PAN Yamin , WANG Tiantian , WANG Shuzhi , LU Rui , WANG Shuping , HUANG Hui , SHI Zhimei.

Department of Endoscopy， Eastern Hepatobiliary Hospital， Second Military Medical University， Shanghai 200438， China;

Corresponding author：

Keywords：

Biliary tract neoplasm; Cholangiopancreatography; Endoscope; Self-expandable metallic stent

Video：

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Objective To evaluate the safety and efficacy of simultaneous endoscopic bilateral placement of selfexpandable metal biliary stents in malignant hilar biliary obstruction． MethodFrom May 2007 to December 2010, a total of 24 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ underwent endoscopic retrograde cholangiopancreatography (ERCP) and bilateral metal stent placement. Technical success rate, functional success rate, ERCP related complications, stents’ patency time, and patient’ survival time were recorded and reviewed． Results Twentyone of 24 patients were followedup for average 39 months. Technical success rate was 100%, the average operation time was （36.2±13.9） min, the functional success rate was 95.45%. Mild cholangitis occurred in 2 cases and there was no ERCP related pancreatitis, bleeding, perforation, and death. Stents dysfunction occurred in 7 within followup period. Amonge them, plastic stents were inserted through the metallic stents in 4 cases, PTCD was required in 1 case, and conservative therapy was given in the other 2 cases. The median stent’ patency time and median patient’ survival time were 253 d (95% CI: 199.79-306.21) and 229 (95% CI : 154.53-303.47）, respectively, with no significant differences between Bismuth classification types. ConclusionEndoscopic simultaneous bilateral biliary metal stent placement is technically feasible, safe, and effective to malignant hilar obstruction.

Citation： GAO Daojian,HU Bing,PAN Yamin,WANG Tiantian,WANG Shuzhi,LU Rui,WANG Shuping,HUANG Hui,SHI Zhimei.. Efficacy of Endoscopic Bilateral Biliary Metal Stent Placement for Malignant Hilar Biliary Obstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(6): 585-589. doi: Copy

1.	Guthrie CM, Haddock G, De Beaux AC, et al. Changing trends in the management of extrahepatic cholangiocarcinoma [J]. Br J Surg， 1993, 80(11): 14341439.
2.	Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [J]. Hepatogastroenterology， 2000, 47(34): 927931.
3.	Johnson SR, Kelly BS, Pennington LJ, et al. A single center experience with extrahepatic cholangiocarcinomas [J]. Surgery， 2001, 130(4): 584590.
4.	Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion [J]. Gut， 1991, 32(6): 685689.
5.	Deviere J, Baize M, de Toeuf J, et al. Longterm followup of patients with hilar malignant stricture treated by endoscopic internal biliary drainage [J]. Gastrointest Endosc， 1988, 34(2): 95101.
6.	Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice [J]. Gut， 1989, 30(8): 11321135.
7.	Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction [J]. Lancet， 1994, 344(8938): 16551660.
8.	Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice [J]. Lancet， 1987, 2(8550): 5762.
9.	Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus selfexpanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study [J]. J Clin Gastroenterol， 2008, 42(9): 10401046.
10.	Davids PH, Groen AK, Rauws EA, et al. Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction [J]. Lancet， 1992, 340(88348835): 14881492.
11.	Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial [J]. Endoscopy， 1993, 25(3): 213218.
12.	Sherman S. Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? [J]. Gastrointest Endosc， 2001, 53(6): 681684.
13.	De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study [J]. Gastrointest Endosc， 2001, 53(6): 547553.
14.	Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage [J]. Gastrointest Endosc， 1998, 47(5): 354362.
15.	Cheng JL, Bruno MJ, Bergman JJ, et al. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of selfexpandable metallic Wallstents [J]. Gastrointest Endosc， 2002, 56(1): 3339.
16.	Eisen GM, Dominitz JA, Faigel DO, et al. An annotated algorithmic approach to malignant biliary obstruction [J]. Gastrointest Endosc， 2001, 53(7): 849852.
17.	胡冰, 陆蕊, 徐福宁, 等. 内镜下同期放置双侧金属胆道支架的方法探讨 [J]. 中华消化内镜杂志， 2009, 26(7): 339343.
18.	Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer [J]. World J Surg， 1988, 12(1): 3947.
19.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc， 1991, 37(3): 383393.
20.	De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study [J]. Gastrointest Endosc， 2003, 58(1): 5053.
21.	Lee JH, Kang DH, Kim JY, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent [J]. Gastrointest Endosc， 2007, 66(2): 364369.
22.	Dumas R, Demuth N, Buckley M, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique [J]. Gastrointest Endosc， 2000, 51(3): 334338.
23.	Park do H, Lee SS, Moon JH, et al. Newly designed stent for endoscopic bilateral stentinstent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos) [J]. Gastrointest Endosc， 2009, 69(7): 13571360.
24.	Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stentwithinstent placement for malignant hilar biliary obstruction [J]. Gastrointest Endosc， 2010, 71(1): 195199.
25.	Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction [J]. J Gastroenterol Hepatol， 2009, 24(4): 552557.

1. Guthrie CM, Haddock G, De Beaux AC, et al. Changing trends in the management of extrahepatic cholangiocarcinoma [J]. Br J Surg， 1993, 80(11): 14341439.
2. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [J]. Hepatogastroenterology， 2000, 47(34): 927931.
3. Johnson SR, Kelly BS, Pennington LJ, et al. A single center experience with extrahepatic cholangiocarcinomas [J]. Surgery， 2001, 130(4): 584590.
4. Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion [J]. Gut， 1991, 32(6): 685689.
5. Deviere J, Baize M, de Toeuf J, et al. Longterm followup of patients with hilar malignant stricture treated by endoscopic internal biliary drainage [J]. Gastrointest Endosc， 1988, 34(2): 95101.
6. Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice [J]. Gut， 1989, 30(8): 11321135.
7. Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction [J]. Lancet， 1994, 344(8938): 16551660.
8. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice [J]. Lancet， 1987, 2(8550): 5762.
9. Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus selfexpanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study [J]. J Clin Gastroenterol， 2008, 42(9): 10401046.
10. Davids PH, Groen AK, Rauws EA, et al. Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction [J]. Lancet， 1992, 340(88348835): 14881492.
11. Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial [J]. Endoscopy， 1993, 25(3): 213218.
12. Sherman S. Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? [J]. Gastrointest Endosc， 2001, 53(6): 681684.
13. De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study [J]. Gastrointest Endosc， 2001, 53(6): 547553.
14. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage [J]. Gastrointest Endosc， 1998, 47(5): 354362.
15. Cheng JL, Bruno MJ, Bergman JJ, et al. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of selfexpandable metallic Wallstents [J]. Gastrointest Endosc， 2002, 56(1): 3339.
16. Eisen GM, Dominitz JA, Faigel DO, et al. An annotated algorithmic approach to malignant biliary obstruction [J]. Gastrointest Endosc， 2001, 53(7): 849852.
17. 胡冰, 陆蕊, 徐福宁, 等. 内镜下同期放置双侧金属胆道支架的方法探讨 [J]. 中华消化内镜杂志， 2009, 26(7): 339343.
18. Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer [J]. World J Surg， 1988, 12(1): 3947.
19. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc， 1991, 37(3): 383393.
20. De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study [J]. Gastrointest Endosc， 2003, 58(1): 5053.
21. Lee JH, Kang DH, Kim JY, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent [J]. Gastrointest Endosc， 2007, 66(2): 364369.
22. Dumas R, Demuth N, Buckley M, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique [J]. Gastrointest Endosc， 2000, 51(3): 334338.
23. Park do H, Lee SS, Moon JH, et al. Newly designed stent for endoscopic bilateral stentinstent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos) [J]. Gastrointest Endosc， 2009, 69(7): 13571360.
24. Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stentwithinstent placement for malignant hilar biliary obstruction [J]. Gastrointest Endosc， 2010, 71(1): 195199.
25. Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction [J]. J Gastroenterol Hepatol， 2009, 24(4): 552557.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy of Endoscopic Bilateral Biliary Metal Stent Placement for Malignant Hilar Biliary Obstruction

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