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Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction

BACKGROUND/AIMS: Although endoscopic bilateral stent-in-stent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large ce...

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Autores principales: Yang, Min Jae, Kim, Jin Hong, Hwang, Jae Chul, Yoo, Byung Moo, Lee, Sang Hyub, Ryu, Ji Kon, Kim, Yong-Tae, Woo, Sang Myung, Lee, Woo Jin, Jeong, Seok, Lee, Don Haeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Editorial Office of Gut and Liver 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254615/
https://www.ncbi.nlm.nih.gov/pubmed/29938453
http://dx.doi.org/10.5009/gnl17468
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author Yang, Min Jae
Kim, Jin Hong
Hwang, Jae Chul
Yoo, Byung Moo
Lee, Sang Hyub
Ryu, Ji Kon
Kim, Yong-Tae
Woo, Sang Myung
Lee, Woo Jin
Jeong, Seok
Lee, Don Haeng
author_facet Yang, Min Jae
Kim, Jin Hong
Hwang, Jae Chul
Yoo, Byung Moo
Lee, Sang Hyub
Ryu, Ji Kon
Kim, Yong-Tae
Woo, Sang Myung
Lee, Woo Jin
Jeong, Seok
Lee, Don Haeng
author_sort Yang, Min Jae
collection PubMed
description BACKGROUND/AIMS: Although endoscopic bilateral stent-in-stent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. METHODS: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. RESULTS: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. CONCLUSIONS: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement.
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spelling pubmed-62546152018-11-26 Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction Yang, Min Jae Kim, Jin Hong Hwang, Jae Chul Yoo, Byung Moo Lee, Sang Hyub Ryu, Ji Kon Kim, Yong-Tae Woo, Sang Myung Lee, Woo Jin Jeong, Seok Lee, Don Haeng Gut Liver Original Article BACKGROUND/AIMS: Although endoscopic bilateral stent-in-stent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. METHODS: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. RESULTS: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. CONCLUSIONS: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement. Editorial Office of Gut and Liver 2018-11 2018-08-09 /pmc/articles/PMC6254615/ /pubmed/29938453 http://dx.doi.org/10.5009/gnl17468 Text en Copyright © 2018 by The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Yang, Min Jae
Kim, Jin Hong
Hwang, Jae Chul
Yoo, Byung Moo
Lee, Sang Hyub
Ryu, Ji Kon
Kim, Yong-Tae
Woo, Sang Myung
Lee, Woo Jin
Jeong, Seok
Lee, Don Haeng
Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title_full Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title_fullStr Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title_full_unstemmed Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title_short Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary Obstruction
title_sort prospective multicenter study of the challenges inherent in using large cell-type stents for bilateral stent-in-stent placement in patients with inoperable malignant hilar biliary obstruction
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254615/
https://www.ncbi.nlm.nih.gov/pubmed/29938453
http://dx.doi.org/10.5009/gnl17468
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