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Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)

BACKGROUND: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this...

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Autores principales: Yamamura, Masahiro, Ogura, Takeshi, Ueno, Saori, Okuda, Atsushi, Nishioka, Nobu, Yamada, Masanori, Ueshima, Kazuya, Matsuno, Jun, Yamamoto, Yoshitaro, Higuchi, Kazuhide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058454/
https://www.ncbi.nlm.nih.gov/pubmed/35509423
http://dx.doi.org/10.1177/17562848211062803
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author Yamamura, Masahiro
Ogura, Takeshi
Ueno, Saori
Okuda, Atsushi
Nishioka, Nobu
Yamada, Masanori
Ueshima, Kazuya
Matsuno, Jun
Yamamoto, Yoshitaro
Higuchi, Kazuhide
author_facet Yamamura, Masahiro
Ogura, Takeshi
Ueno, Saori
Okuda, Atsushi
Nishioka, Nobu
Yamada, Masanori
Ueshima, Kazuya
Matsuno, Jun
Yamamoto, Yoshitaro
Higuchi, Kazuhide
author_sort Yamamura, Masahiro
collection PubMed
description BACKGROUND: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this device for patients with unresectable malignant hilar biliary obstruction (MHO) after multiple UCSEMS deployments. METHOD: Participants comprised consecutive patients with unresectable MHO who had undergone multiple UCSEMS deployments and required endoscopic revision for the right or left hepatic bile ducts, as decided by cholangiography under endoscopic retrograde cholangiopancreatography (ERCP) guidance. RESULTS: A total of 14 patients requiring endoscopic revision of right and left hepatic bile ducts were enrolled in this study. Among these 14 patients, guidewire insertion through the mesh of previously placed stents failed in 2 patients. As a result, these two patients underwent only unilateral UCSEMS deployment. Because clinical success was not obtained, transmural placement of the UCSEMS under Endoscopic Ultrasound (EUS) guidance to the segment of the liver not being drained was performed in those patients. The molting technique was attempted in 12 patients, proving successful in all patients. The technical success rate was therefore 92.8% (12/14). Mean procedure time was 23.2 min. CONCLUSION: This novel stent delivery system with a dilation function may be useful in endoscopic revision techniques for bilateral UCSEMS deployment.
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spelling pubmed-90584542022-05-03 Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos) Yamamura, Masahiro Ogura, Takeshi Ueno, Saori Okuda, Atsushi Nishioka, Nobu Yamada, Masanori Ueshima, Kazuya Matsuno, Jun Yamamoto, Yoshitaro Higuchi, Kazuhide Therap Adv Gastroenterol Original Research BACKGROUND: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this device for patients with unresectable malignant hilar biliary obstruction (MHO) after multiple UCSEMS deployments. METHOD: Participants comprised consecutive patients with unresectable MHO who had undergone multiple UCSEMS deployments and required endoscopic revision for the right or left hepatic bile ducts, as decided by cholangiography under endoscopic retrograde cholangiopancreatography (ERCP) guidance. RESULTS: A total of 14 patients requiring endoscopic revision of right and left hepatic bile ducts were enrolled in this study. Among these 14 patients, guidewire insertion through the mesh of previously placed stents failed in 2 patients. As a result, these two patients underwent only unilateral UCSEMS deployment. Because clinical success was not obtained, transmural placement of the UCSEMS under Endoscopic Ultrasound (EUS) guidance to the segment of the liver not being drained was performed in those patients. The molting technique was attempted in 12 patients, proving successful in all patients. The technical success rate was therefore 92.8% (12/14). Mean procedure time was 23.2 min. CONCLUSION: This novel stent delivery system with a dilation function may be useful in endoscopic revision techniques for bilateral UCSEMS deployment. SAGE Publications 2022-04-29 /pmc/articles/PMC9058454/ /pubmed/35509423 http://dx.doi.org/10.1177/17562848211062803 Text en © The Author(s), 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Yamamura, Masahiro
Ogura, Takeshi
Ueno, Saori
Okuda, Atsushi
Nishioka, Nobu
Yamada, Masanori
Ueshima, Kazuya
Matsuno, Jun
Yamamoto, Yoshitaro
Higuchi, Kazuhide
Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title_full Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title_fullStr Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title_full_unstemmed Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title_short Endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
title_sort endoscopic bilateral revision after metal stent deployment for hepatic hilar obstruction using molting technique (with videos)
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058454/
https://www.ncbi.nlm.nih.gov/pubmed/35509423
http://dx.doi.org/10.1177/17562848211062803
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