Cargando…

The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions

Background: In the case of an unresectable malignant hilar biliary obstruction (MHBO), the optimal drainage method has not yet been established. Recently, an 8 mm, fully covered, self-expandable metal stent (FCSEMS) with an ultra-slim introducer has become available. In this article, the results of...

Descripción completa

Detalles Bibliográficos
Autores principales: Matsubara, Saburo, Nakagawa, Keito, Suda, Kentaro, Otsuka, Takeshi, Oka, Masashi, Nagoshi, Sumiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605161/
https://www.ncbi.nlm.nih.gov/pubmed/36294431
http://dx.doi.org/10.3390/jcm11206110
_version_ 1784817996464652288
author Matsubara, Saburo
Nakagawa, Keito
Suda, Kentaro
Otsuka, Takeshi
Oka, Masashi
Nagoshi, Sumiko
author_facet Matsubara, Saburo
Nakagawa, Keito
Suda, Kentaro
Otsuka, Takeshi
Oka, Masashi
Nagoshi, Sumiko
author_sort Matsubara, Saburo
collection PubMed
description Background: In the case of an unresectable malignant hilar biliary obstruction (MHBO), the optimal drainage method has not yet been established. Recently, an 8 mm, fully covered, self-expandable metal stent (FCSEMS) with an ultra-slim introducer has become available. In this article, the results of whole-liver drainage tests using this novel FCSEMS for MHBO are reported. Methods: Unresectable MHBOs up to Bismuth IIIa with strictures limited to the secondary branches were eligible. The proximal end of the stent was placed in such a way as to avoid blocking the side branches, and the distal end was placed above the papilla when possible. Consecutive patients treated between April 2017 and January 2021 were retrospectively analyzed. The technical and functional success rates, rates and causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), revision for RBO, and adverse events (AEs) were evaluated. Results: Eleven patients (Bismuth I/II/IIIa: 1/7/3) were enrolled. Two stents were placed in nine patients and three were placed in two patients. Both the technical and functional success rates were 100%. RBO occurred in four (36%) patients due to sludge formation. Revision was performed for three patients, with the successful removal of all stents. The median TRBO was 187 days, and no late AEs other than the RBO occurred. Regarding the distal position of the stent, the RBO rate was significantly lower (14.3% vs. 75%, p = 0.041) and the cumulative TRBO was significantly longer (median TRBO: not reached vs. 80 days, p = 0.031) in the case of the placement above the papilla than the placement across the papilla. Conclusion: For unresectable MHBOs of Bismuth I, II, and IIIa, whole-liver drainage with a novel 8 mm FCSEMS possessing an ultra-slim introducer was feasible and potentially safe, with favorable stent patency. Placement above the papilla might be preferrable to placement across the papilla.
format Online
Article
Text
id pubmed-9605161
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-96051612022-10-27 The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions Matsubara, Saburo Nakagawa, Keito Suda, Kentaro Otsuka, Takeshi Oka, Masashi Nagoshi, Sumiko J Clin Med Article Background: In the case of an unresectable malignant hilar biliary obstruction (MHBO), the optimal drainage method has not yet been established. Recently, an 8 mm, fully covered, self-expandable metal stent (FCSEMS) with an ultra-slim introducer has become available. In this article, the results of whole-liver drainage tests using this novel FCSEMS for MHBO are reported. Methods: Unresectable MHBOs up to Bismuth IIIa with strictures limited to the secondary branches were eligible. The proximal end of the stent was placed in such a way as to avoid blocking the side branches, and the distal end was placed above the papilla when possible. Consecutive patients treated between April 2017 and January 2021 were retrospectively analyzed. The technical and functional success rates, rates and causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), revision for RBO, and adverse events (AEs) were evaluated. Results: Eleven patients (Bismuth I/II/IIIa: 1/7/3) were enrolled. Two stents were placed in nine patients and three were placed in two patients. Both the technical and functional success rates were 100%. RBO occurred in four (36%) patients due to sludge formation. Revision was performed for three patients, with the successful removal of all stents. The median TRBO was 187 days, and no late AEs other than the RBO occurred. Regarding the distal position of the stent, the RBO rate was significantly lower (14.3% vs. 75%, p = 0.041) and the cumulative TRBO was significantly longer (median TRBO: not reached vs. 80 days, p = 0.031) in the case of the placement above the papilla than the placement across the papilla. Conclusion: For unresectable MHBOs of Bismuth I, II, and IIIa, whole-liver drainage with a novel 8 mm FCSEMS possessing an ultra-slim introducer was feasible and potentially safe, with favorable stent patency. Placement above the papilla might be preferrable to placement across the papilla. MDPI 2022-10-17 /pmc/articles/PMC9605161/ /pubmed/36294431 http://dx.doi.org/10.3390/jcm11206110 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Matsubara, Saburo
Nakagawa, Keito
Suda, Kentaro
Otsuka, Takeshi
Oka, Masashi
Nagoshi, Sumiko
The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title_full The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title_fullStr The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title_full_unstemmed The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title_short The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant Hilar Biliary Obstructions
title_sort feasibility of whole-liver drainage with a novel 8 mm fully covered self-expandable metal stent possessing an ultra-slim introducer for malignant hilar biliary obstructions
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605161/
https://www.ncbi.nlm.nih.gov/pubmed/36294431
http://dx.doi.org/10.3390/jcm11206110
work_keys_str_mv AT matsubarasaburo thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT nakagawakeito thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT sudakentaro thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT otsukatakeshi thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT okamasashi thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT nagoshisumiko thefeasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT matsubarasaburo feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT nakagawakeito feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT sudakentaro feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT otsukatakeshi feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT okamasashi feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions
AT nagoshisumiko feasibilityofwholeliverdrainagewithanovel8mmfullycoveredselfexpandablemetalstentpossessinganultraslimintroducerformalignanthilarbiliaryobstructions